yin – American Institute of Acupuncture

Systemic Lupus Erythematosus

acuherb — Wed, 22 Aug 2012 18:36:43 +0000

By Dr. Kenneth Wang

Systemic lupus erythematosus (SLE) is a chronic, inflammatory disorder ofÂ connective tissueÂ that usually arises without obvious cause and is regarded as anÂ autoimmune disease. It affects many different organ systems of the body and varies in severity between patients and, over time, within the same patient.

Typical features of SLE are a symmetrical red rash to the face, arthritis and progressive damage to the kidneys.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect the joints and many organs of the body, commonly the skin and kidneys. The disease course can range from mildly episodic to severe, and can be fatal. Symptoms vary from individual to individual and are characterized by remission and exacerbation. The complex presentation of the disease can make diagnosis difficult.

No definitive term exists for SLE in the ancient Chinese medical classics. Individuals are diagnosed with different syndromes according to the presentation of symptoms and are treated according to the disharmony patterns displayed under these syndromes.

	Symptoms of fever and skin rash are diagnosed asÂ yin-yang poisoning,Â Prurigo, itching dermatitis of the face, cheek sores and solar dermatitis syndromes.
	Joint pain, muscle pain andÂ Raynaud’s phenomenonÂ are classified asÂ bi-syndrome.
	Heart involvement, causing symptoms of palpitations and shortness of breath, is referred to asÂ palpitationÂ syndrome.
	Nervous system symptoms are grouped asÂ hysteriaÂ syndrome.
	Symptoms resulting from multipleÂ asthenia syndromeÂ organ systems involvement are classified as . This can then lead toÂ consumptive disease.
	Kidney involvement is defined asÂ kidney deficiency.

The kidneys are very important in TCM and are considered (as in Western medicine) to be commonly involved in SLE.

As SLE is a disease that can affect the whole body and involve several organs, different syndromes or disharmony patterns may occur at the same time and present a multiplicity of symptoms.

Causes

The cause of SLE remains unknown, although it is thought that genetic, hormonal, immune and environmental factors have a role. The reasons that support this are:Â

	Relatives of patients with SLE are at increased risk of developing the disease.
	The disease is more often seen in both of a pair of identical twins than it is in fraternal (non-identical) twins.
	Prevalence of the disease in certain races also implies a genetic (inherited) influence in the occurrence of SLE.
	Evidence for hormonal abnormalities is based primarily on the observation that SLE is much more common among women in their childbearing years.

Many abnormalities of theÂ immune systemÂ occur in patients with SLE. The reason for this remains unclear and it is not known which are primary and which are secondary causes. These abnormalities in immune regulation are thought to result from loss of “self” (substances belonging to the body) tolerance. This means that SLE patients are no longer totally tolerant of all their self-antigensÂ and consequently anÂ immune responseÂ develops to these antigens.Â

From the traditional Chinese medicine (TCM) viewpoint, the major cause of SLE is an inborn insufficiency that disturbs the balance ofÂ yin and yang. SLE may be acquired whenÂ environmental pathogensÂ (dryness, dampness, cold, summer-heat, wind and fire evils) affect this balance. Inborn insufficiencies or acquired disorders also lead to depletion of vital energy (qi) and yin fluid. This can cause impaired functioning of the body and a defect in resistance to illness.

Ancient TCM classics like theÂ Jinkui Yaolue (Summary from the Golden Chest)Â refer to diseases that poison the yin-yang balance. Constitutional or bodily weakness enables environmental pathogens to invade the body. This disturbs the harmonious balance of yin and yang and illness results. As an example, over-exposure to sunlight, considered to be a heat evil, causes the accumulation of heat and toxic pathogens in the body, and this in turn triggers organ system damage. Diseases where yang is dominant in the body present withÂ yang-type symptoms, such as flushing of the face, high fever, dislike of heat, dark-colored urine or constipation. Diseases dominated by yin present withÂ yin-type symptoms, such as pallor, cold limbs, an aversion to cold, pale urine or watery stools.

Parallels can be made with Western medicine’s understanding of SLE. For example, SLE is a result of the malfunction of the body’s immune system, which in TCM can be interpreted as a yin and yang imbalance. Genetic and environmental factors are also known to play a role in the development of SLE. It has been suggested that a virus may be partially responsible for its cause. This thinking is in line with the TCM concepts of environmental pathogens and an inborn deficiency being linked to the occurrence of SLE.

Symptoms

The onset of SLE can be highly variable, as can be the progression of the disease. Early symptoms may be non-specific and include muscular pain, nausea, vomiting, headaches, depression and easy bruising. Sometimes symptoms are more specific and more than one may be present. Symptoms may be mild or severe, fleeting or persistent.

General symptoms

	FatigueÂ occurs in virtually all patients with SLE and may be experienced with the onset of SLE or only with a relapse of the disorder.
	Swelling of the ankles is common.
	There is often a gain or loss in body-weight.
	Low-grade fever is seen in 80 per cent of patients.
	It is usually an episodic disease (occurs from time to time).

Skin and mucous membranes
The skin is affected in over 70 per cent of cases. Often, rashes occur after exposure to ultraviolet light and such exposure may lead to major flares involving other organ systems as well. Abnormal sensitivity to sunlight is experienced by about half of all patients with SLE and is more common in those who are fair and light-skinned.

Typical ”butterfly” distribution facial rash seen in SLE.

A classical characteristic of SLE is the “butterfly” rash that occurs across the face. Hair-loss is also common. Mouth ulcers occur frequently in active disease, but they may be relatively painless. A painful throat may accompany a flare.

Vascular system (blood vessels)Â
A disorder of the vascular system known asÂ Raynaud’s phenomenonÂ occurs in 20 to 30 per cent of patients. Classically, the fingers turn white followed by a bluish cyanotic hue, finally replaced by a red flush as dilatation of the blood vessels occurs. The full three-color change does not always happen, but excessive sensitivity of the hands to the cold is common.

Musculoskeletal system
Painful and arthritic joints are the most common symptoms of SLE and experienced by almost all patients. Symptoms can occur in any joint and often clear up in one to three days. Fingers, hands wrists and knees are the most commonly affected. Less frequently, ankles, elbows, shoulders and hips are involved. Stiffness on waking can last several minutes.

Renal system
In 50 per cent of SLE patients, the kidneys become involved. There may be rapid onset of an acute and painful kidney inflammation or traces of blood or protein may be found on analysis of the urine. Urinary tract infections are common.

Nervous systemÂ
Nervous disorders occur in virtually all SLE patients. Anxiety and/or depression are common in response to the illness and the threat of loss of health, family and job. The prospect of disability and dependency can be very distressing.

Symptoms may include insomnia, loss of appetite, constipation, palpitations, diarrhea, over-breathing, memory loss, emotional instability, confusion and decreased concentration. Seizures (convulsions) occur in more than 10 per cent of patients. The incidence of stroke, with resulting abnormalities of sensation and power, is similar.

Headaches are a frequent complaint and are usually due to stress and tension. Migraine occurs in 20 per cent of patients.

Cardiorespiratory systemÂ
Chest pain, cough and breathlessness occur frequently. These result from a variety of processes involving the lungs, the lining of the chest wall and diaphragm. Pain on breathing is commonly experienced and is often accompanied by chest discomfort. It may be worsened by lying down.

Gastrointestinal tract
Involvement of the gastrointestinal tract is common. Up to 25 per cent of patients have esophageal complaints, including difficulty swallowing. Indigestion, abdominal pain, nausea and vomiting are also common.

Blood
Anemia occurs in at least 50 per cent of patients. On laboratory analysis, abnormalities in the blood cells and clotting mechanisms are commonly found.

TCM practitioners will examine the sufferer and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during different stages of the disease. The presentation of SLE is often complicated, but some common patterns can be classified:

	Excessive toxic heat accumulation
	Individuals present with persistent high-grade fevers, the appearance of a rash on the face or other areas, joint pain, muscle soreness or pain, fatigue, thirst and a desire for cold drinks. Irritability, insomnia, constipation and production of dark-colored, scanty urine are also common. In severe cases, loss of consciousness, delirium, muscle spasms, bruising or petechiae (small, flat blood spots under the skin), the spitting up of blood and the presence of blood in the urine or stool may also occur. Exposure to sunlight and the ingestion of certain foods or drugs are factors that can exacerbate the disease and induce flare-ups.
	bloodÂ yin deficiency
	In this deficiency there is a persistent low-grade fever, a hot sensation in the chest, palms and soles of the feet, irritability, fatigue and a reluctance to speak. There is general swelling of tissues, redness of the face, spontaneous perspiration and night sweats, and loin and joint pain.
	Toxic factor attacking theÂ heart
	Symptoms include palpitations, shortness of breath, chest fullness with a feeling of oppression and local heat, spontaneous perspiration, pallor and cold limbs.
	KidneyÂ yin deficiency
	Individuals usually experience pain in the back, legs and feet, limb weakness and a sensation of hotness in the face. In more serious cases, sores appear in the mouth and on the tongue, hot sensations are felt in the chest, palms and soles of the feet, and the individual feels emotionless. Sometimes low-grade fever and swelling may be present.
	Impairment of theÂ liverÂ due to heat
	In this disharmony pattern, pain in the upper sides of the abdomen, abdominal distension, irregular and painful menstruation in females, skin rashes, bruising, insomnia, dizziness and loss of appetite are commonly experienced.

Diagnosis

The diagnosis of systemic lupus erythematosus can be difficult. The disease may present in many different ways and most of the laboratory tests carried out on patients with SLE are not specific. For these reasons, other diseases have to be carefully considered before a diagnosis of SLE can be made. Physicians should always consider the possibility of SLE in a disease which is affecting many systems of the body, especially those involving the skin and joints of young women.

In 1982, the American College of Rheumatology compiled a list of 11 criteria, at least four of which should be present, not necessarily at the same time, to make a diagnosis of SLE. In some patients, only one or two criteria may be present initially and after several weeks, months or even years do the others appear. These criteria are:

	Characteristic “butterfly” rash on the face
	Generalized skin rash
	Mouth ulcers
	Arthritis
	Sensitivity to ultraviolet light
	Inflammation of the lining of the chest wall or the membrane surrounding the heart
	Renal (kidney) disorder
	Nervous system disorder
	Low red or white blood cell count
	Positive antinuclear antibodies
	Positive lupus anticoagulant

These last two are immunologic laboratory tests.

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:

	Questioning: The TCM practitioner will establish the medical history of both the patient and his family.
	Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
	Listening and swelling: The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
	Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In SLE, the disharmony patterns present at different stages during the course of the disease and can be described as follows: :

	Excessive toxic heat accumulation
	In TCM, it is held that the occurrence of SLE is closely related to over-heating of theÂ heart meridian. The heart controls the blood and blood vessels. When the heart pumps, blood is transported within the vessels around the entire body. The heart,Â bloodÂ and blood vessels are thus united by their common activities. When heat pathogens are congested in the heart meridian, it means a serious invasion of the internal organs has occurred. The qi and blood bring these pathogens to every part of the body, damaging internal organs, muscles and skin along the way. On examination, the tongue appears red or dark red and ulcerated, or sores may be present on the inside of the mouth. The tongue may be coated with a fur that is greasy and yellow, dry and yellow, greasy and white, or the fur may be absent altogether. The pulse feels taut and rapid.
	Blood yin deficiency
	When the body accumulates too many heat pathogens over a period of time, the body fluids dry up and organs will not function properly. This decreases the production of blood andÂ kidney essenceÂ and leads to a morbid condition of general weakness with sweating, low-grade fevers and hot sensations in the palms and soles of the feet.On examination, the tongue appears red with a white fur coating or with no coating. The pulse sign feels thready, rapid and weak.
	Toxic factor attacking the heart
	Impairment of the functioning of several internalÂ organsÂ signals involvement of the heart and a serious effect to the bloodflow. Individuals present with pallor, palpitations and cold extremities.On examination, the tongue is pale and coated with thin white fur. The pulse feels thready, weak, or choppy.
	Kidney yin deficiency
	This occurs usually in a late stage of the disease when the pathogens finally invade the kidney. Kidney-yin refers to the fluid andÂ essenceÂ stored in the kidneys. The invading pathogens cause a deficiency in the amount of this fluid and essence and the kidneys begin to over-function. This is the yang part of the kidney compensating for the loss of yin and creates aÂ virtual fireÂ in the kidneys. This produces back pain, limb weakness and heatsymptoms such as fever or tongue sores.On examination, the tongue appears bulky, moist and pale. The tip of the tongue may also be red. The pulse feels deep, thready and weak.
	Impairment of the liver due to heat
	Heat pathogens dry up body fluid and this leads to inadequate nourishment for theÂ liver. In TCM thinking, the liver helps regulate qi and blood movement, and the digestive function of theÂ spleen. Individuals with this disharmony pattern present with pain in the liver region, bleeding problems or loss of appetite.On examination, an enlarged liver and spleen may be palpable.

Treatment

The management of SLE should be comprehensive and include drug and non-drug treatment. Therapy is individualized for each patient depending on the manifestations of disease and their severity.Â

Corticosteroids
SystemicÂ corticosteroidÂ therapy is the mainstay of treatment in SLE. However, not all patients require steroids, and steroids can do more harm than good. When needed, oral maintenance doses of prednisone or prednisolone are usually prescribed.

Severe symptoms affecting the whole body, such as sustained high fevers and severe blood disorders, often need to be treated with higher doses of corticosteroids. Involvement of organs such as the heart, lungs, and central nervous system also usually requires treatment with corticosteroids.

A topical steroid is usually prescribed for skin rashes.

NSAIDs
Mild symptoms of arthritis and muscular pain are usually managed with non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, naproxen and ketoprofen. More severe symptoms may need an antimalarial agent and occasionally low doses of corticosteroids may be required.

Antimalarials
The antimalarials chloroquine and hydroxychloroquine possess anti-inflammatory properties and have been found of benefit in treating inflammatory conditions which have an immunologic basis. They are usually used when other first-line therapies (such as NSAIDs) fail. They are prescribed for more severe skin and joint manifestations of SLE.

Immunosuppressants
As long-term corticosteroid therapy, particularly at the higher doses, tends to cause side-effects, immunosuppressants such as azothiaprine, cyclophosphamide and methotrexate are sometimes added in an attempt to lower the dose of corticosteriod required. These drugs suppress theÂ immune response. As immunosuppressants themselves pose a risk of long-term toxicity they need to used with care, but can be useful in the treatment of acute and severe organ involvement.

Psychiatric support
The threat of a chronic disease can be very stressful. Visiting a doctor frequently and having many laboratory tests with long waits for the results can be an emotional burden.Â Emotional support in the treatment of SLE is essential. It is also important that patients have extensive rest.

Preventive measuresÂ
All possible means to prevent provocation or exacerbation of SLE should be undertaken. Â As SLE is an episodic disease and is characterized by exacerbation and remission, it is extremely important to withdraw therapy slowly when an exacerbation has quieted down. This avoids unnecessary drug toxicity.

Patients with SLE need a to see their doctors at least once every three to six months, even if the disease is inactive.Â Patients with active disease must be assessed more frequently.

Treatment of SLE from a TCM perspective will depend on the symptoms of the individual patient. In addition to herbalÂ decoctionsÂ used to alleviate disharmony pattern symptoms, treatment may include acupuncture for relieving pain and stiffness in the joints, andÂ qi-gongÂ to help focus the energy of the body in fighting the disease and strengthening the mind.

Examples of decoctions used for the different disharmony patterns

Excessive toxic heat accumulation

Therapeutic aim:To clear away heat and toxins, cool down the blood, protect theÂ yin, remove obstructions in theÂ meridiansÂ and clear up rashes.

Prescription:Â Qingying decoction

shi gao	gypsum
shu di huang	processed rehmannia root
mai dong	dwarf lilyturf tuber
zhi mu	common anemarrhena root
niu xi	achyranthes root

For individuals with high fever, poor concentration and delirium, the dosages of heat-clearing drugs should be increased or the following added:

shang shi gao	unprocessed gypsum
huang lian	golden thread
da huang	rhubarb

Some patent Chinese medicines likeÂ Purple Snowy Pill, Bezoar Bolus for ResurrectionandÂ Treasured BolusÂ can be taken at the same time.

Yin blood deficiency

Therapeutic aim:To replenish the yin, nourish and cool down theÂ blood, and eliminate toxins.

Prescription:Â Modified Zhibai Dihuang pill

zhi mu	common anemarrhena root
huang bai	amur cork-tree
shu di	processed rhemannia root
shan yu rou	Asiatic cornelian cherry fruit
shan yao	common yam root
ze xie	oriental water-plantain root
dan pi	tree peony bark
fu ling	Indian bread

For individuals withÂ spleenÂ deficiency add:

bai zhi	large head atractylodes root
chen pi	dried tangerine peel
fu ling	Indian bread

In cases of very high fever add:

yin hua

honeysuckle flower

For dizziness add:

ju hua	chrysanthemum flower
chuan xiong	Szechwan lovage root

Toxic factor attacking the heart

Therapeutic aim:To nourish the yin, replenish theÂ qi, calm the mind, and clear away heat and toxins.

Prescription:Â Modified Huanglian antidote decoction

huang lian	golden thread
huang qin	baical skullcap root
huang bai	amur cork tree
zhi zi	Cape jasmine fruit

For spleen deficiency add:

dang shen	pilose asiabell root
bai zhi	large head atractylodes root

For individuals with a feeling of chest fullness add:

hou po	magnolia bark
su geng	perilla stem

For yin deficiency add:

yu zhu	fragrant Solomon’s seal rhizome
huang jing	agastache or Solomon’s seed
dong chong xia cao	Chinese caterpillar fungus

Kidney yin deficiency

Therapeutic aim:To nourish the yin, tonify theÂ kidneys, activate the blood circulation and eliminate toxins.

Prescription:Â Modified Siwu decoction

dang gui	Chinese angelica
chuan xiong	Szechwan lovage root
shu di	processed rehmannia root
bai shao	white peony root

For dampness-heat symptoms in the lower burner add:

che qian zi	plantain seed
Bi xie	long yam
qu mai	Chinese pink herb

For individuals with backache add:

tu si zi	dodder seed
chuan duan	Himalayan teasel root

For joint pain add:

ji xue teng	suberect spatholobus stem
shen jin cao	common club-moss herb
liu ji nu	diverse wormwood herb
xu chang qing	paniculated swallow-wort root

Impairment of the liver due to heat

Therapeutic aim:To nourish the yin, cool down the blood, eliminate toxins, activate the blood circulation, clear away blood stasis and remove obstructions in the meridians.

Prescription:Â Modified Xiefu Zhuyu decoction

tao ren	peach seed
hong hua	safflower flower
dang gui	Chinese angelica
sheng di	common yam root
chuan xiong	Szechwan lovage root
chia hao	red peony root
niu xi	achyranthes root
jie geng	platycodon root
chai hu	Chinese tororwax root
zhi qiao	orange fruit
gan cao	liquorice root

For individuals with severe blood stasis add:

san leng	bur-reed tuber
e zhu	zedoary rhizome
yi mu cao	motherwort herb
chuan xin lian	andrographis herb
gui jian yu	winged spindle tree

For severe abdominal distention and pain below the ribs add:

hou po	magnolia bark
chen pi	dried tangerine peel
xiang fu	nut-grass

For qi deficiency and residual heat toxins add:

huang qi	milk-vetch root
qin jiao	large-leafed gentian
wu she	black snake

For over heated blood and a well-defined rash add:

ji guan hua	cockscomb
mei gui hua	rose
ling xiao hua	trumpet creeper flower

Dr. Wang who is expert on treatment of SLE Â RA with his spacial prepared herb medicine in over thirty year experience in clinic and Â with Acupuncture treatment can very good control the disease and stop pain joint swollen.

What is the Yin Yang Theory?

acuherb — Fri, 29 Jun 2012 15:38:05 +0000

By Kenneth Wang Â OMD Â PhD. LAc.Â

Â Introduction to Yin and YangÂ

Modern symbol of Yin Yang
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Yin yang theory is a kind of logic, which views things in relation to its whole. The theory is based on two basic components: yin and yang, which are neither materials nor energy. They combine in a complementary manner and form a method for explaining relationships between objects. Gradually, this logic was developed into a system of thought that was applied to other areas. Traditional Chinese Medicine (TCM) is an example of one area where the yin yang theory is used to understand complicated relationships in the body.

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The Origin of the Yin Yang Theory

Early Daoism representation of Yin Yang
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The original concept of yin and yang came from the observation of nature and the environment. “Yin” originally referred to the shady side of a slope while “yang” referred to the sunny side. Later, this thinking was used in understanding other occurrences, which occurred in pairs and had complementary and opposing characteristics in nature. Some examples include: sky and earth, day and night, water and fire, active and passive, male and female and so on. Working with these ideas, ancient people recognized nearly all things could have yin and yang properties. Yin and yang can describe two relative aspects of the same phenomena such as the example of the slope, or they can describe two different objects like sky and earth.

Usually, yang is associated with energetic qualities. For example, movement, outward and upward direction, heat, brightness, stimulation, activity and excitement are all yang qualities. Yin, on the other hand, is associated with the physical form of an object and has less energetic qualities such as rest, inward and downward direction, cold, darkness, condensation, inhibition, and nourishment. See Table 1 for a description of yin and yang characteristics.

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General Qualities of Yin and Yang

Yin	Yang
Darkness	Light
Moon	Sun
Feminine	Masculine
Shade	Brightness
Rest	Activity
West (Sunset = Yin)	East (Sunrise = beginning of Yang)
North	South
Earth	Heaven
Right	Left
Flat (like Earth)	Round (like Heaven)
Matter	Energy
More material/dense	Non-material, rarefied

These transform into one another.

They are 2 states of a continuum. For Example: Liquid water (Yin) heat – vapor (Yang) – cools – liquid (Yin).

Yin	Yang
Produces form	Produces energy
Grows	Generates
Substantial	Non-substantial
Matter	Energy
Contraction	Expansion
Descending	Rising
Below	Above
Water	Fire

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Four Main Aspects of Yin and Yang Relationship

Yin-Yang are opposites
They are either on the opposite ends of a cycle, like the seasons of the year, or, opposites on a continuum of energy or matter. This opposition is relative, and can only be spoken of in relationships. For example: Water is Yin relative to steam but Yang relative to ice. Yin and Yang are never static but in a constantly changing balance.
Interdependent: Can not exist without each other
The Tai Ji (Supreme Ultimate) diagram shows the relationship of Yin & Yang and illustrates interdependence on Yin & Yang. Nothing is totally Yin or totally Yang. Just as a state of total Yin is reached, Yang begins to grow. Yin contains seed of Yang and vise versa. They constantly transform into each other. For Example: no energy without matter, no day without night.
The classics state: “Yin creates Yang and Yang activates Yin”.
Mutual consumption of Yin and Yang
Relative levels of Yin Yang are continuously changing. Normally this is a harmonious change, but when Yin or Yang are out of balance they affect each other, and too much of one can eventually weaken (consume) the other.
Four (4) possible states of imbalance:
1. Preponderance (Excess) of Yin
2. Preponderance (Excess) of Yang
3. Weakness (Deficiency) of Yin
4. Weakness (Deficiency) of Yang
Inter-transformation of Yin and Yang.
One can change into the other, but it is not a random event, happening only when the time is right. For example: Spring only comes when winter is finished.

Yin and Yang Theory and History

Yin Yang is the fundamental principle, and the most important theory in TCM, underlying all physiology, pathology & treatment.

Combining the two, we have the four stages of Yin and Yang

With addition of an extra line, the Eight Trigrams (Ba Gua) were formed, illustrating all the directions.

The Eight Trigrams were combined to form 64 hexagrams, symbolizing all possible phenomena of the Universe.

Yin Yang had been understood for many centuries, but was systematically elaborated and written down by Tsou Yen of the Yin Yang (Naturalist) School in the Warring States Period (476-221 BC).

5 Element Theory was developed at same time.

The Naturalist school promoted idea of living in harmony with natural laws. Scholars of this school interpreted natural phenomena and observed how these are reflected in the human body in health and disease. Yin and Yang and the Five Elements became an integral part of Chinese philosophy.

The ancients observed 2 phases of constant cyclical change. Yin constantly changes into Yang & back into Yin again. This can be seen in the changes of four seasons, and the changes throughout a single day (24 Hour Cycle), as seen below.

24 Hour Yin Yang Cycle

(12 PM corresponds to Utmost Yang, while 12AM corresponds to Utmost Yin)

The Application of Yin Yang Theory in Traditional Chinese Medicine

Application in human body structures & Physiological:

Yin

Yang

Front (chest-abdomen) Back

Body Head

Interior (organs) Exterior (skin, muscles)

Below waist Above waist

Anterior-medial Posterior-lateral

ventral surface of the trunk and limbs back and dorsal surface of the limbs

Structure Function

Blood/Body Fluids Qi

Conservation/storage Transformation/change

Yin Organs: Heart, Lung, Small Intestine, Lg. Intestine

Liver, Spleen, Kidney, Gall Bladder, Stomach, Bladder

Pericardium San Jiao

“Solid Organs” “Hollow Organs”

Front and Back

Front is more soft and vulnerable (Yin). Back contains spine that holds ribs: protection. When human depicted as crouching, back receives sun (Yang) and front faces the earth (Yin), is in shade and is protected.

All Yang channels (except the Stomach channel) flow on the dorsal or dorsolateral surface of the trunk and limbs. They carry Yang energy and protect the body from pathogenic factors. Yin channels flow on the anterior or anteromedial surface of the trunk and limbs.

Body and HeadÂ

Yang channels either end or begin on the head. Acupuncture points on the head can be used to raise Yang energy . When Yang energy is not cooled by Yin, it may rise to the head, causing signs such as red face and eyes. The head is easily affected by Yang pathogens such as heat and wind. The chest and abdomen (Yin) areas are more easily affected by Yin pathogens such as Cold and Dampness.

Interior and Exterior

The exterior of the body such as the skin and muscles is more Yang. The exterior protects body from attack by external pathogenic influences such as Cold, Wind, etc. The classics state: “Yang is on the outside and protects Yin”.

Below the waist and Above the Waist

Below waist – closer to earth (Yin). Above, closer to Heaven (Yang).
Upper part more affected by Yang pathogens, i.e. wind.
Lower part more affected by Yin pathogens, i.e. cold damp.

Anterior/Medial and Posterior/Lateral Surface of the Limbs

Yin channels flow on anterior-medial aspect of trunk/limbs
Yang channels flow on posterior-lateral aspect of trunk/limbs

Structure and Function

Structure = something substantial, i.e. Matter (Yin)
Function = something insubstantial, action, energy (Yang)
All parts of the body have a structure (a physical form), and a function (their activity)
However, all is relative. Even within the Yang category of function, there are Yin functions (i.e. storage, conservation) and Yang functions, i.e. transformation, transportation, digestion, excretion.
Within the Yin category of form there are Yin forms (“solid”) and Yang forms (“hollow”)

Blood, Body Fluids, and Qi

Qi is Energy, more Yang.
Blood = denser and more material (therefore Yin).
But note that “Xue” (blood) not exactly like our concept of Blood. More like “thicker” form of Qi.

Note: there are several types of Qi. Each is relatively more Yin or Yang.Â
Ancestral QI (more Yin, more slow moving. Moves in long slow cycles).
Ying Qi (more Yang than Ancestral Qi, moves with Blood with which it is closely related). Ying is more Yin than Wei Qi.
Wei Qi the most Yang form of Qi. Circulates in the exterior in the daytime to protect us from pathogenic influences, and regulates opening/closing of pores.

Conservation/Store (Yin) and Transformation/Change (Yang)

Yin Organs store Blood, Body Fluids, Essence, etc.
Yang Organs constantly transform, transport and excrete the products of digestion.

Solid and Hollow Organs (Zang Fu)

Yin Organs are “Solid”: constantly active, involved in production and storage of the body’s vital Substances (Qi Blood, Body Fluids, Essence)

Yang Organs are “Hollow”: receive and circulate but do not store, involved in digestion, transformation, excretion.

Application in Pathology

Clinical signs and symptoms can be interpreted via Yin-Yang theory. When Yin Yang are in dynamic balance and relating harmoniously, there are no symptoms to observe. When Yin and Yang are out of balance, they become separated.Â

For example: a.) Yin does not cool and nourish Yang so Yang rises (headaches, red face, sore eyes, sore throats, nosebleeds, irritability, manic behavior. b.) Yang does not warm and activate Yin (cold limbs, hypo-activity, poor circulation of blood, pale face, low energy. Actual symptoms depend on specific pathologies, which Organ involved, etc.

Yin

Yang

Deficiency Excess

Hypo-activity Hyperactivity

Chronic disease/gradual onset Acute disease/rapid onset

Slowly changing symptoms Rapid pathological changes

Quiet, lethargy, sleepiness Restlessness, insomnia

Wants to be covered Throws off bedclothes

Lies curled up Lies stretched out

Cold limbs and body Hot limbs and body

Pale face
Red face

Weak voice, no desire to talk Loud voice, talkative

Shallow, weak breathing Coarse breathing

No thirst/wants warm drinks Thirst esp. for cold drinks

Copious, clear urine Scanty, dark urine

Loose stools (fluids not transformed) Constipation (damage to fluids by heat)

Clear, copious secretions Thick, sticky white/yellow secretions

Excessive moisture Excessive dryness (throat, skin, eyes etc.)

Degenerative disease Inflammatory disease

Pale tongue, white coat Red tongue, yellow coat

Empty pulse Full pulse

In Practice:

Although Yin-Yang essential foundation for understanding symptoms and signs, the above list of signs is too general. We need to distinguish further to get exact diagnosis. i.e., which Organ is involved, which pathogen involved, which channel involved.

Structure and Function
Without structure, function could not occur. Without function, structure would be meaningless.

Mutual Consumption of Yin and Yang
Balance of Yin & Yang is constantly changing. Yin & Yang mutually consume each other.Â

Four different situations:

1) Excess of Yin 2) Excess of Yang

3) Deficiency of Yin 4) Deficiency of Yang

Excess of Yin: i.e., when excess Cold in the body consumes the Yang (heat). This is an Excess Cold (Full Cold) condition.

Excess of Yang: i.e., when excess Heat (from Exterior or Interior of body) consumes Body Fluids, leading to Dryness or even Heat. This is an Excess Heat (Full Heat) condition.

Deficiency of Yin (Consumption of Yin): i.e., when the body’s Yin energy is depleted, an apparent excess of Yang results, leading to feelings of “empty heat” (mild but very specific heat symptoms, i.e., flushed cheeks, afternoon fever, sweating at night, heat in extremities. This is Deficiency Heat (Empty Heat) condition (i.e., a condition of deficiency and heat), also called “False Fire”.

Deficiency of Yang (Consumption of Yang). When body’s Yang energy is spontaneously deficient – an apparent excess of Yin results, leading to various symptoms involving cold and hypo-activity Deficiency of Yang can also occur after an Excess Cold condition has damaged Yang. This is an Deficiency Cold (Empty Cold) condition (i.e., a condition of deficiency and cold).

Excess of Yin (Full Cold) Excess of Yang (Full Heat)

Excess of Yin is primary aspect Excess of Yang is primary aspect

Yin is in true excess Can eventually cause deficiency of Yin

Can eventually cause deficiency of Yang Â

Â Â

Deficiency of Yang (Consumption of Yang) Deficiency of Yin (Consumption of Yin)

(Empty Cold) (Empty Heat of “False Fire”)

Decrease of Yang energy is primary aspect Deficiency of Yin is primary aspect

Yin only apparently in excess Yang only apparently in excess

Inter-transformation of Yin and Yang in Medicine

In medicine also, Yin and Yang transform into one another, but only when conditions are right. The right moment determined by internal qualities of the given situation or phenomenon.
In clinical practice, the above principle is important.

Disease is prevented by achievement of BALANCE in lifestyle i.e., excessive work (Yang) without rest leads to deficiency (Yin) of energy i.e., excessive consumption of cold food (Yin) leads to deficiency of body’s Yang energy i.e., smoking (= putting heat (Yang) into Lungs) leads to deficiency of Yin of Lungs (and eventually Kidneys)

The principle is observable in pathological changes seen in disease i.e., Exterior cold (cold weather) can invade body and can change to heat (sore throat). i.e., Deficiency of Yang of i.e., Spleen. Because Spleen Yang is used to transform fluids, these can build up to cause Excess Interior Dampness (Yin).

Diagnostic application :

TCM diagnoses patients according to their disharmony pattern. Preliminarily, all patterns are classified into a system known as the “eight principal patterns.” The “eight principal patterns” contain four pattern pairs: interior and exterior, cold and heat, deficiency and excess, and yin and yang. Among the eight patterns, yin and yang are the most fundamental and essential pattern pair. (See Table .). Generally speaking, yang signs are associated with excitatory, active, hot, progressing externally and developing upward and improving manifestations. Yin signs, on the other hand, are associated with inhibitory, resting, passive, cold, progressing internally and developing downward and worsening manifestations. Table 3 illustrates the clinical signs of yin and yang patterns.Â

Eight Principal Disharmony Patterns

Â Disharmony Pattern Yin/Yang Manifestations

1 Exterior Yang An exterior pattern is generated by “external influences” such as wind and cold. (i.e. common cold)

2 Interior Yin An interior pattern is generated by internal disharmony such as a disorder of organ function.

3 Cold Yin A cold pattern is manifested by the signs such as a pale face, cold limbs, aversion to cold, clear urine, or watery stools. The signs are usually related to non-excitatory physiological functions.

4 Heat Yang A heat pattern is manifested by signs of a red face, high fever, dislike of heat, dark urine, or constipation. The signs are usually related to excitatory physiological functions.

5 Deficiency Yin Signs of frail and weak movements, tiredness, shortness of breath, low voice, or dizziness indicate a deficiency pattern. The signs are usually related to lack of energy of normal functions.

6 Excess Yang An excess pattern exhibits signs of heavy movements, heavy and coarse respiration, or discomfort when touched with pressure. The signs are usually related to an excess/accumulation of evils/metabolic waste.

7 Yin Yin General pattern groups for Yin manifestations include interior, cold and deficiency patterns.

8 Yang Yang General pattern groups for Yang manifestations include exterior, heat and excess patterns.

Â Yin and Yang signs in the body

Body signs
Yang signs Yin signs

Face Red face, fever, hot feeling, agitated and active manner Pale face, low spirit, feels cold, cold limbs, tired and weak,

Voice Coarse and strong voice, coarse breath, dry moth, thirst Low voice, reduced appetite, no taste in mouth, little thirst

Urine Constipation with awkward smell, dark urine Copious and clear urine

Tongue Red and scarlet tongue or yellow and black moss present on tongue Pale and swollen tongue material

Pulse Rapid and floating, flooded and strong, slippery and full pulse Slow and sinking, weak, frail pulse

Yin and Yang and the Six Pathogenic Factors

Yin

Yang

Â Wind

Cold Heat

Dampness Dryness

Â Summerheat

Application in treatment:

In general, every treatment modality aims to:

Tonify Yang

Tonify Yin

Disperse excess Yang

Disperse excess Yin

(In practice, depending on the condition, strategies may be combined, for example: disperse excess Yin & tonify Yang)

Herbs and their Yin and Yang PropertiesÂ

TCM also classifies herbs of different “natures” and “tastes” according to their yin and yang properties. Cold and cool nature herbs belong to yin while hot and warm herbs belong to yang. Yin herbs taste sour, bitter and salty, and yang herbs taste sweet and pungent. The yin yang theory also describes the effects of herbs. Herbs with floating and ascending properties are part of yang while herbs with sinking and descending properties are part of yin. In choosing the correct herbs for treatment using TCM, it is essential to first identify the disharmony pattern and then select herbs with the appropriate nature, taste and effect. By following these simple steps, Traditional Chinese Medicine can help maintain the body’s balance and health.

Prostate Cancer

acuherb — Tue, 03 Apr 2012 01:53:34 +0000

By Dr. Ken Y Wang

Prostate cancer is one of the most common cancers affecting men, especially elderly men in their sixties, seventies and eighties. It has been suggested that if every man lives long enough, he will eventually develop prostate cancer. In western countries, it is the cancer most frequently found in men after skin cancer. The disease is less common among Asian men, though rates in Asian populations are rising; something thought to be due to the increased levels of red meat and animal fat in Asian diets.Â

The prostate is a walnut shaped gland that wraps itself around the urinary outlet tube, the urethra, just under the bladder and in front of the rectum in human males. Females do not have this organ or any equivalent organ. The prostate produces a protein-rich fluid that nourishes and supports the sperm produced by the testicles. The sperm and prostatic fluid together form the semen ejaculated by males during orgasm.

As men age, the prostate enlarges, a condition known asÂ benign prostatic hypertrophy, and symptoms caused by pressure on the bladder and the urethra develop. These include more frequent urination, a difficulty starting urination, pain on urinating and difficulty passing urine. In some cases, when the prostate enlarges the cells undergo a cancerous change. In many men, this happens so slowly they never know they have cancer. Some cases have been diagnosed as an “incidental finding” during the post-mortems done on men who have died from other causes. But in others, the cancerous change can be rapid and the prostate cancer can spread beyond the prostate into other organs, usually the bones of the pelvis and spine, before the man has symptoms. There is new evidence that a particular tumour gene, known as P53 indicates whether the man has a tumour likely to spread rapidly or grow slowly. If P53 is present in the tumour, it is usually a much more aggressive and dangerous cancer.

The incidence of prostate cancer is low in China, but has risen significantly in recent years. This is thought to be due to lifestyle changes such as eating increased levels of red meat and animal fat. The current western thinking about prostate cancer did not exist in ancient China. Instead, prostate cancer would have been described according to its symptoms of “strangury”, “retention of urine” (inability to urinate) and “haematuria” (blood in urine). In Traditional Chinese Medicine (TCM) like western medicine, “strangury” means dribbling urination and frequent urination with prickling pain or pain radiating to the lower abdomen. This symptom can also be present in other health conditions such as certain types of venereal disease, benign prostatic hypertrophy, and some bladder diseases. “Retention of urine” occurs when the prostate enlarges, as is often the case with prostate cancer, and blocks the bladder’s outflow.Â

The TCM perspective of how fluid is processed and urine is made is important in the development of prostate cancer:
Because there is no historical understanding of the prostate organ in Traditional Chinese Medicine, the organs that control urine production and excretion play a crucial part in the treatment of prostate cancer. TheÂ lung,Â spleenÂ andÂ kidneyÂ all have roles in fluid metabolism and in regulating its distribution. TheÂ upper, middle and lower burnersÂ act together as the distribution pathway for body fluids. All body fluids will gather finally in the kidney, where they will be separated into fluid that can be reused by the body or “turbid’ water that cannot. The “turbid” water is then sent to theÂ bladderÂ for excretion as urine. TCM describes this fluid regulation and the excretion function as “vaporization“. The bladder, as in western medicine, is responsible for storing and excreting urine. Disharmony of the bladder can lead to urinary problems such as incontinence or difficultly urinating. Kidney function complements bladder function so a problem with the bladder often indicates kidney problems as well. The kidney organ, in TCM, is additionally responsible for sexual function.

Understanding how urine is formed from a TCM perspective

Â

Causes

TCM believes health is achieved whenÂ yin and yangÂ are in harmony. The body’s physical form belongs to yin while the body’s activities or functions belong to yang. Because both the body’s physical form and functions are dynamically balanced, they mutually restrict and depend on one another. Hence, in TCM disease results from either a deficiency of vital energyÂ (qi)Â (diagnosed as a deficiency of yin fluid or a deficiency of yang qi) or an excess of the “pernicious evils” (excess of yin evils or yang evils).Â Pernicious evils are factors outside the body that cause disease. The conflict between resuming vital energy and getting rid of the “pernicious evils” is what allows the disease to either progress or transform back to a healthy state.

According to TCM theory, prostate cancer is caused byÂ heat, stasisÂ orÂ deficiencyproblems. Heat is considered a pernicious evil. (See above for definition.) Stasis or deficiency problems, which are described below in more detail, stem from a deficiency of vital energy (qi).

Heat:

The concept of heat includes two types: “damp-heat evil” and “hyperactivity of excessive ministerial fire.” Damp heat evil occurs when there is an over consumption of greasy foods and alcohol. This leads to a malfunction of theÂ stomachÂ andÂ spleenÂ and causes a build up of damp heat that flows downwards, attacks the bladder and impairs theÂ vaporization functionÂ responsible for fluid regulation. (See definition section.) Symptoms like dribbling urine, frequent urination with or without prickling pain and periodic retention of urine can develop when this happens.

Ministerial fire is the source of heat power in the human body. In TCM, it is believed that when a man is overly sexually active, theÂ kidneyÂ essence is consumed and the internal ministerial fire becomes excited. The excessive ministerial fire is a kind of “evil fire” which makes the body produce heat. This “evil fire” affects theÂ lungs,Â bladderÂ andÂ triple burnerÂ and impairs the passage of body fluids. As a result, symptoms of urinary frequency and dribbling urine with prickling pain may occur.Â

Stasis:Â

Stasis occurs when a particular substance cannot flow smoothly. In TCM, stasis happens when there is stagnation ofÂ qiÂ or blood flow. TheÂ kidneysÂ play an important part in the vaporization of body fluids. In this process, fluids are separated by the kidneys to ones that can be reused by the body or into “turbid water” which is eventually excreted as urine. When the emotion rage impairsÂ liverÂ function, the surrounding vital energy or qi stagnates and cannot flow properly, eventually transforming into an “evil-fire.” As the “evil fire” accumulates in theÂ lower burner, the vaporization process is affected and so is normal urination.

Qi is the commander and controller of the body’s blood. Once qi flow stagnates, blood circulation will not be smooth, and this can lead to difficulty urinating and to bloody urine (haematuria).Â

Deficiency:Â

Deficiency problems refer mainly to kidney failure, which results from the damage done by the above mentioned causes of heat and stasis. In summary, sexual excess and improper diet both lead to an accumulation of damp heat and ministerial fire, which contribute to qi stagnation and blood stasis. These, in turn, eventually exhaust kidney –yin, which is the foundation supplying fluid to the entire body for moistening and nourishing purposes. Once kidney yin is completely exhausted, kidney failure will ensue.Â

Other Causes of Prostate Cancer:
Other factors associated with the development of prostate cancer are still under further investigation.
These include:Â

	high levels of male hormones
	excessive sexual activity
	gonorrhea
	other causes of urinary tract infections
	A chronic intake of greasy food leading to a disorder in hormone metabolism.

Symptoms

Modern TCM practitioners mostly follow western theories when assessing prostate cancer symptoms. Initially there may be no symptoms present at all. When the prostate cancer enlarges to a level where it blocks urinary outflow, dribbling urination, frequent urination with prickling pain or pain radiating to the lower abdomen (strangury) and urine retention are commonly seen. Haematuria (blood in the urine) usually appears at a later stage of disease involvement.Â

The presence of damp heat in the body or overstrain strangury can cause thirst with a lack of desire to drink, constipation, burning and stabbing pain during urination, or dribbling urine. Overstrain strangury means the body is overworking and makes the strangury symptoms more severe.Â

Stagnation of qi flow and blood stasis are usually present when urine retention occurs. (See causes section.) Symptoms related to these conditions include lower abdominal distension, localized pain, difficultly urinating or inability to urinate.Â

Haematuria can be a manifestation of hyperactive and excessive ministerial fire. Related symptoms arising from excessive ministerial fire include face blushing, excessive thirst, feeling annoyed or distracted, insomnia, urinary hesitancy and pain on urination.Â

Other signs that may be present with prostate cancer:

The tongue signs:Â

Individuals with damp heat usually have a red tongue with yellow and greasy fur. Those with blood stasis have a dark tongue with pinpoint bruises, and those who suffer from exhausted kidney yin have a red or deep red tongue without fur.Â

The pulse signs:

A rolling and rapid pulse is present in people with damp heat problems. Individuals with blood stasis often have a hesitant pulse, and those with kidney–yin exhaustion have a soft, thready and weak pulse.Â

Prostate cancer is famous for being silent: that is, causing no symptoms able to warn of its presence. Many are diagnosed during a routine physical examination or after a screening blood test known as a Prostate Specific Antigen (PSA) has been done. When symptoms do appear, they are usually similar to those caused by enlargement of the prostate (benign prostatic hypertrophy-described in the definition section).Â

These include:

	Increased urinary frequency, especially at night
	Difficulty starting urination
	Difficulty passing urine
	Pain on passing urine

Symptoms more suggestive of prostate cancer include:

	Blood in the urine
	Pain in the pelvis and spine
	Weight loss
	Night sweats
	Severe tiredness

Diagnosis

Diagnosis of prostate cancer mainly depends on western methodologies because the concept of a prostate organ did not exist originally in Traditional Chinese Medicine. Examination of a man’s prostate organ through the rectum is usually done during routine physical check ups to detect its size and texture. Ultrasound and CT (computed tomography) scans are very helpful for diagnosis and locating areas to which the disease may have spread. Other measures include looking for cancer cells in prostatic fluid or from a fine needle biopsy of the prostate. Recently prostate specific antigen (PSA) blood tests have been used to screen for early prostate cancer in older men, usually those over fifty.Â

Prostate cancer can only be differentiated from benign prostatic hypertrophy by using modern medical investigations. Benign prostatic hypertrophy occurs when the prostate gland enlarges and puts pressure on the bladder and urethra (the urinary outflow tract from the bladder). In TCM and western medicine, there are no big differences between prostate cancer and benign prostatic hypertrophy symptoms. Likewise, the TCM tongue and pulse signs are similar for both conditions. However, benign prostatic hypertrophy, while able to cause significant discomfort and put dangerous backpressure on the kidney, is not a form of cancer and does not metastasize (spread to other parts of the body).

In TCM, the diagnosis is not prostate cancer per se but rather a classification of its symptoms into five different syndromes, which are outlined below. The general progression of prostate cancer from a TCM perspective goes from damp-heat flowing downward in the body to stagnation of qi and blood stasis to hyperactivity of heart-fire and hyperactivity of excessive ministerial fire, finally leading to kidney failure.

Diagnosis is based on four important examination techniques. The first is “questioning.” The TCM practitioner will want to know important information such as what your current complaints are, your past medical history and family health history. The second technique is “observation.” Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest are important. The last technique used in examination is “touching.” Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about imbalance in the body. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.

Features of the TCM syndromes associated with prostate cancer are:Â

Damp-heatÂ
Damp-heat is heavy and likes to flow downward and accumulate in the lower burner (bladder, large intestine) region, which results in frequent, difficult and/ or urgent urination. The tongue appears red with a yellow and greasy covering, and the pulse is rolling and rapid with this syndrome.Â

Kidney-Yin Exhaustion
Under normal conditions, kidney–yin & kidney–yang restrict, promote, and depend on each other in order to maintain a dynamic balance of yin & yang. This means the kidneys are kept in a constant state of functioning where they are not over or under functioning. When kidney–yin becomes exhausted and cannot perform its usual functions, kidney yang cannot be kept in check and the body experiences virtual heat symptoms. These symptoms manifest as urinary frequency and urgency, dry throat, restlessness, dry and hard stools, hot feelings in the palms, lower back, knee soreness and weakness of the lower extremities. The tongue appears red without a mossy covering, and the pulse feels thready and soft.Â

Decline of Kidney-Yang
This type is seldom encountered but is very serious. Kidney-yang is the main source of energy for life’s activities. Therefore, if kidney–yang declines, the body will be unable to perform warming and promoting functions, causing a yang-deficiency in many other organs, which may lead to death. Individuals usually feel weak and fatigued. They have pale complexions, cold limbs, sore loins (waist area) and experience an aversion to cold temperatures. Urinary symptoms associated with this condition include urinary frequency, dribbling urination and a weak urine stream. The tongue appears pale with a thin fur layer, and the pulse feels deep and weak.

Stagnation of QiÂ
When qi movement is sluggish, it causes improper fluid circulation. Symptoms related to improper fluid circulation include difficulty urinating, inability to urinate, emotional depression, irritability, quick temper and chest and abdominal distension. The pulse is stringy, and the tongue is red with a yellowish, thin fur. Those who also have blood stasis (poor blood flow) will have a dark tongue with pinpoint bruises and a hesitant pulse.Â

Hyperactivity of Heart-fire
A kidney–yin deficiency can also affect the heart by disrupting its normal functions and creating a “heartÂ fire evil” or heart-yang excess. When this happens, the blood vessels become damaged and the blood leaks out. Urinary symptoms related to this condition include haematuria (blood in the urine), prickling pain on urination and dark-colored urine. Other symptoms include insomnia, feeling annoyed and the presence of boils on the mouth and tongue. On examination, the tongue usually has a red tip, sometimes with a prickly appearance and a thin or yellowish fur coating. The pulse feels thready and rapid.Â

If one suffers from hyperactivity of excessive ministerial fire, symptoms such as hyper-sexuality, a red tongue with a thin or yellowish fur and a rolling and rapid pulse will be present. (See causes section under heat for further explanation.)

Treatment

Surgery

If the cancer has been diagnosed early, is still within the prostate gland itself and is of a type considered unlikely to spread rapidly, surgical removal of the entire prostate, an operation known as a radical prostatectomy, may be considered. However, this operation has a high rate of complications, leaving up to up to sixty percent of men impotent and more than ten percent with incontinence (where they cannot control urine flow). This is because the nerves controlling these functions are very close to where the prostate sits under the bladder. The sphincter, a muscle that holds the bladder closed, is located just above the prostate and is also vulnerable to damage during surgery. In expert hands, that is, when done by a surgeon who does many of these procedures at a hospital where the operating theatre and nursing staff are very experienced in prostate surgery, the complication rates are much lower. Some surgeons in top American hospitals report incontinence in only two percent of their patients and impotence in ten percent. For this reason, choosing your surgeon very carefully once you have been diagnosed with operable prostate cancer is essential. It is worth getting several opinions and asking each surgeon for their post-surgery complication rates. If they will not give you this information, ask your usual medical adviser to help you find out who has the lowest complication rates.Â

Radiotherapy

Those men whose tumours are too advanced for surgery, who are considered unsuitable for surgery, or who would like to avoid the complications of surgery, may be given radiotherapy, where a radiation beam is directed at the prostate to burn away the cancer. This treatment may also be used to burn away secondary prostate cancers in the pelvic bones and spine to stop the pain caused by such tumours. In the right men, who are carefully selected according to the size and stage of their tumour, brachytherapy, a treatment where tiny radioactive implants are inserted into the prostate cancer, has been very successful.Â

Chemotherapy

Advanced tumours or those thought likely to spread even after surgery may be treated with a combination of drugs able to kill cancer cells, known as chemotherapy. Doses and courses vary according to the oncologist’s assessment of which chemical is likely to be most effective but courses are usually given over several months.Â

Hormone therapy

Because prostate cells are very sensitive to the male hormone testosterone, hormone therapy is given, usually as a long-acting injection, to block the effect of testosterone and delay the spread of advanced prostate cancer. Sometimes both testicles are surgically removed to achieve the same effect without using drugs. Unfortunately, this has marked side effects such as breast development, impotence, loss of sexual desire, and a change from a low to a higher voice, but it can effectively slow down the progression of the disease.

There are many ways to treat prostate cancer after a definitive diagnosis has been made. Western treatment methods: hormone therapy, surgery, chemotherapy and radiotherapy are important for curing or arresting disease progression. (See western medicine section.) However, due to the different side effects each option causes (i.e. inability to control urination, impotence and loss of sexual desire), these clinical methods still have limitations.Â

TCM focuses on holistic healing and creating a harmonious balance in the body. The yin and yang philosophy is central to achieving balance and is used to identify good and evil health influences, distinguish between body excesses & deficiencies and to regulate the functions of the organs, qi, and blood. TCM can complement western medicine by helping to increase therapy efficacy, improve quality of life and in some cases prolong the lifespan.Â

Surgery is an area in which TCM treatments can be especially useful. The mere act of surgery causes damage to a person’s body by exhausting its healthy energy and increasing blood loss causing an imbalance of yin and yang. TCM herbal preparations and other treatments such as acupuncture or qi gong used before and after the operation can reduce the damage from intra and post-operative complications, improve operation tolerance and promote health restoration. Before surgery, TCM preparations that invigorate qi, enrich the blood, strengthen the spleen and nourish the kidney and liver are generally chosen. Afterwards, preparations that tonify qi, nourish yin, promote blood circulation, resolve blood stasis, regulate the function of the spleen and stomach and improve the function the kidney and liver are used to restore the body’s health. Herbal prescriptions are adjusted when complicating factors such as a build up of phlegm, dampness, stasis, toxins and heat evils are impeding recovery. Aside from surgery, TCM herbal preparations have been shown in research studies to improve the efficacy of chemotherapy and radiotherapy and reduce their side effects. When deciding what herbal treatments to take, it is always best to consult a qualified TCM physician who can plan follow up visits with you to monitor how successful a particular treatment has been and to ensure the right care is being given.

Below are some examples of selected herbal prescriptions that are used by TCM doctors to treat the different syndromes associated with prostate cancer.Â

Pathogenic Damp-heat accumulation in lower burnerÂ
Therapeutic aim: Clear away damp-heat in the lower burner
Prescription: Sanmiao pellet

cang shu	atractylodes root
huang bai	amur cork-tree
niu xi	twotooth-achyranthes root

Addition for individuals with dribbling after urination:Â

shi wei	shearer’s pyrrosia leaf
bi xie	dioscorea hypoglauca root
tu fu ling	glabrous greenbrier root

Addition for individuals with haematuria: (Blood in urine)

da ji	Japanese thistle herb
xiao ji	field thistle herb
niu xi	twotooth (charred)

Therapy for Kidney-Yin ExhaustionTherapeutic aim:Â Nourish kidney–yin.Prescription:Â Zhibai Bawei pelletÂ

zhi mu	common anemarrhena root
huang bai	amur cork-tree
sheng di	rehmannia root
shan yu ru	Asiatic cornelian cherry fruit
fu ling	Indian bread
ze xie	oriental water plantain root
shan yao	common yam root

Addition for individuals with severe cases:

gui ban

tortoise shell

Therapy for Decline of Kidney-YangTherapeutic aim:Â Warm and nourish kidney–yang.Â
Prescription:Â Jisheng Shenqi pelletÂ

shu di	rehmannia root (processed)
shan yu ru	Asiatic cornelian cherry fruit
shan yao	common yam root
niu xi	twotooth-achyranthes root
che qian zi	plantain seed
fu zi	prepared common monkshood daughter root
rou gui	cassia bark

Addition for individuals with severe cases:

lu jiao shuang	(degelatined)deerhorn
or	or
lu rong	pilose antler
ren shan	ginseng

Syndrome differentiation must be accurate when using these medicinal substances for warming and nourishing kidney–yang. They should not be used for those withhyperactivityÂ of excessive ministerial fire.Â

Therapy for Hyperactivity of Heart-fireTherapeutic aim:Â Eliminate heart-fire.Prescription:Â Daochi powderÂ

sheng di	rehmannia root
zhu ye	bamboo leaf
sheng gan cao	unprocessed liquorice root
mu tong	vine of clematis armandi

Addition for individuals with urgency or dribbling after urination:

niu xi tan	charred twotooth-achyranthes root
ren dong hua	honeysuckle flower
tu fu ling	glabrous greenbrier root

Therapy for Stagnation of Qi
Therapeutic aim:Â Regulate the functional activities of vital qi.Â
Prescription:Â Chenxiang powderÂ

chen xiang	Chinese eaglewood wood
shi wei	pyrrosia leaf
chen pi	dried tangerine peel
Huang bu liu xing	cowherb seed
dong kui zi	cluster mallow seed

Addition for individuals with blood stasis:

tao ren	peach seed
hong hua	safflower

Osteoporosis

acuherb — Fri, 30 Mar 2012 19:57:55 +0000

Osteoporosis is a debilitating condition of skeletal fragility that predominantly affects women and is particularly common in the elderly. It is a metabolic bone disease characterized by a parallel reduction in bone mineral density and bone matrix, leading to deterioration of theÂ micro-architecture of boneÂ tissue and impairment of the structural integrity of trabecular bone (the inner part of bone that consists of a meshwork of bony bars with numerous interconnecting spaces containing marrow). The consequence is that although the bone tissue has normal composition and proper mineralization, the bone mass (density) is reduced and the bone becomes more fragile. To establish a diagnosis of osteoporosis, the individual bone mineral density is compared with the peak bone mass measurement in the healthy young adult. This comparison is made by means of standard deviation (SD) units (T scores). Clinically, a patient is said to suffer from osteoporosis if his/her bone density falls 2.5 SD below the mean of normally mineralized bone, calculated in comparison to age-, sex-, and race-matched controls (a T score ofÂ Â 2.5). For example, compared to standardized bone density measurements of the total hip ofÂ 833 mg/cm², in osteoporosis, the same measurements will be lower than 648 mg/cm²(World Health Organization). If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair the ability to walk unassisted and may cause prolonged or permanent disability, or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain and deformity.

Multiple etiologic factors of osteoporosis have been identified, which give the various disease types their names.

	Postmenopausal, estrogen-deficient osteoporosis
	Age-related osteoporosis
	Diet-related bone loss
	Disuse osteoporosis
	Endocrine-mediated bone loss
	Disease-related bone loss
	Drug-induced bone loss
	Heritable osteoporosis

Statistics

Osteoporosis is a major public health concern that affects more than 28 million Americans, 80 per cent of whom are women. Women are more likely than men to develop osteoporosis because, as a group, they have lighter bones, less total calcium, and also lose bone at a rate three times greater than that of men. In the US today, 10 million individuals have the disease and 18 million more have low bone mass, placing them at increased risk for osteoporosis. Ten per cent of African-American women over the age of 50 years have osteoporosis; an additional 30 per cent have low bone density that puts them at risk of developing osteoporosis. Significant risk has been reported in people of all ethnic backgrounds.

The disease accounts for more than 1.5 million fractures per year in the US: one out of every four women by the age of 70 develops an osteoporotic fracture; and one in two women and one in eight men over the age of 50 will have an osteoporosis-related fracture in their lifetime. These fractures include the following (approximate figures):

	300,000 hip fractures
	700,000 vertebral fractures
	250,000 wrist fractures
	300,000 fractures at other sites

Osteoporosis is defined in Western medicine as loss of bone density. The disease is most commonly seen in women and is characterized by reduced bone mass, deterioration of bone tissue and an increased risk of bone fractures. It is induced by a physiological degeneration within the body that affects the formation and loss of bone tissue.

The skeleton is the frame of body that protects the internal organs and allows movement. Cavities within the bone store bone marrow, which nourishes the bones and helps manufacture cells such as red and white blood cells and platelets. TCM believes that bone growth is controlled by theÂ kidneysÂ and that the bone marrow is derived from the essential qi or essence of the kidney, calledÂ jing. In recent years, many bone disorders have been successfully cured by TCM practitioners through treatment of the kidney.Â

In the traditional Chinese medicine (TCM) classicÂ Huang Di Nei Jing (The Yellow Emperor’s Medicine Classic), bone diseases with similar symptoms to osteoporosis were given names like “bone flaccidity syndrome,” “withered bone syndrome,” “arthralgia syndrome” and “bone atrophy syndrome.” These syndromes refer to various kinds of bone diseases, but share the common symptom of reduced bone mass. Modern TCM practitioners believe that the features ofÂ “bone flaccidity syndrome”Â andÂ “bone atrophy syndrome”Â are most consistent with today’s understanding of osteoporosis.

Causes

Bone quality is a significant factor that affects the development of osteoporosis. This parameter is determined by bone mass (as measured by bone density) and also by theÂ micro-architecture of bone. Bone density at any given time depends on both the peak bone density achieved during development and subsequent adult bone loss. Collectively, these affect the relative intactness of bones, with respect to tensile strength, fragility and freedom from fatigue damage. Many studies demonstrate the ability of bone density to predict fractures, especially fragility fractures (those caused by minor trauma). The risks vary depending on the populations studied and on the technique of measuring the bone density.

Nonmodifiable risk factors

	Advanced age :Â Bone density increases dramatically during puberty in response to gonadal hormone release and eventually reaches values in young adults that are nearly double those of children. After peak bone density is reached, bone density remains stable for years and then declines.
	Gender :Â Considerable evidence suggests that bone loss begins before menses cease in women and in the third to fifth decade in men. In women, once the menopause is established, the rate of bone loss is accelerated several-fold. The chances of developing osteoporosis are greater for woman because they have less initial bone tissue and lose it more rapidly because of the changes involved in the menopause.
	*Family history and personal history of fractures as an adult :*Â Susceptibility to fracture may be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass. A personal history of a fracture as an adult also increases fracture risk.
	Race :Â Caucasian and Asian women are more likely to develop osteoporosis..

Potentially modifiable risk factorsÂ

	Bone structure and body weight :Â Small-boned, fair-skinned, and thin women are at greater risk.
	Estrogen deficiency :Â Normal or early menopause (brought about naturally or because of surgical removal of the ovaries) increases the risk of developing osteoporosis. A menstrual history of late-onset menses, or of amenorrhea (absence of menstrual periods) also increases risk.
	*Lifestyle :*Â Stress, smoking, excess alcohol consumption, and a sedentary lifestyle are associated with the development of osteoporosis.
	*Diet :*Â A high intake of caffeine, phosphorous, or protein, and a diet poor in calcium and vitamin D affect bone formation.
	Poor eyesight :Â Impaired eyesight despite adequate correction can lead to falls.
	*Poor health/frailty Medications :Â A number ofÂ drugs*Â taken for other conditions can have an affect on osteoporosis, either because they interfere with bone formation or accelerate its loss.
	Chronic health problems :Â Diseases such as chronic liver disease, chronic liver failure, endocrinopathies (eg, diabetes, hyperthyroidism), malabsorption syndromes, rheumatoid arthritis, and chronic anorexia can also be risk factors for osteoporosis.

From TCM’s viewpoint, osteoporosis is caused by aÂ kidneyÂ deficiency. As people get older, theÂ essential qi (jing)Â of the kidney gradually declines and results in a lack of nutrients for the bones to grow and function properly. This causes the bones to become fragile and break or deform easily. Bone fractures can be hard to heal due to the lack of nourishment and kidney deficiency.

The causes of kidney deficiency leading to osteoporosis are as follows:Â

Exhaustion of kidney essence.
Kidney essenceÂ may be depleted in one of three ways:

	A congenital deficiency (a deficiency you are born with) and the aggravation of external factors, such as excessive sexual activities and frequent childbirth, cause the kidney essence to become severely depleted. This leads to loss of bone nutrients.
	The elderly are especially vulnerable to osteoporosis if they do not take good care of their bodies because the depletion of kidney essence accelerates with age.
	Exogenous pathogensÂ can easily invade and damage the kidney whenÂ vital qi (energy)Â is insufficient. This causes the development of osteoporosis. .

Acquired Deficiency
Under normal conditions, theÂ spleenÂ andÂ stomachÂ are responsible for changing digested nutrients intoÂ qi,Â blood, and acquired (postnatal)Â jing. Over-consumption of alcohol and food can damage the spleen and stomach and reduces the amount of jing available to nourish the bone, bone marrow and muscle. Additionally, when the stomach and spleen dysfunction, a decline in formation of qi and blood results and this can contribute to osteoporosis development.

Invasion of exogenous pathogens
Osteoporosis can occur when external cold and dampness evils, which are exogenous pathogens, invade the body and impair the vital qi (energy) andÂ kidneyÂ qi. This leads to a deficiency ofÂ kidney essence (jing)Â and a failure in the bone marrow to replenish the nutrients needed to retain bone strength. Other symptoms such as lumbago (back pain) and arthralgia (joint pain) can occur when cold and dampness evils stagnate in the tendons and joints, blocking the circulation of qi and blood in that area.Â

TCM followers believe that external cold and dampness pathogens can invade the body under the following conditions:

	Living in cold and moist areas for a long time
	Exposure in a windy place while drinking alcohol
	Bathing or taking a shower while sweating
	Eating too much cold food and
	Lying in damp and moist open areas such as wet grassy fields.

Symptoms

The clinical symptoms of primary osteoporosis are:

	Lumbago (back pain)
	Decrease in body height and /or hump back (kyphosis) giving a stooped appearance
	Bones that easily fracture
	Difficulty in breathing due to malformation of the back limiting the amount of air that can be inhaled.

Persons with osteoporosis will also be diagnosed with a TCM disharmony pattern. (See diagnosis section). Each disharmony pattern displays different symptoms, which are described as follows:

1.	Yin deficiency of theÂ liverÂ andÂ kidneys
Â	The individual experiences soreness and pain in the back and loins, weakness in the loins and knee joints, general weakness and fatigue, dryness of the mouth and throat, a hot sensation in palms and soles, and night sweating or spontaneous sweating.
2.	BloodÂ deficiency and excessive dampness
Â	This manifests as soreness and pain in the back and loins, a hump back, pale complexion, heart palpitations and dizziness. There may also be pain and soreness in the joints or the lower limbs may be swollen.
3.	*Retention of dampness andÂ kidneyÂ deficiency*
Â	This disharmony pattern is characterized by lower back pain, localized chills, weakness and soreness in the loins and knees. In severe cases the lumbar vertebrae (lower back bones may collapse or a hump back develop. Additional symptoms are a cold feeling in the limbs, urinary frequency, and an aversion to the cold. The symptoms may be aggravated in a cold environment or with a drop in the ambient temperature.
4.	*Asthenia-syndrome of superficiesÂ and interior dampness retention*
Â	The individual suffers from pain in the hip and back, joint swelling, sweating and has an aversion to wind (coldness). A sense of heaviness may also be felt.
5.	*Cold in the superficies and heat in the interior*
Â	The symptoms here are body aches and sweating, and an aversion to cold temperatures. Additional symptoms can include dry mouth, thirst, and constipation.
6.	*Marrow deficiency andÂ channel bi-syndrome*
Â	The individual experiences pain in lumbar region. In severe cases, the lumbar vertebrae may collapse or a hump back may occur. Joints can become deformed and develop limited movement. Individuals may also experience dizziness, heart palpitations, and shortness of breath.

Diagnosis

Osteoporosis is an insidious disease that can remain silent for decades before the bone is weakened to the point that it sustains a spontaneous fracture. The earliest signs of osteoporosis are often associated with compression fractures of the spine characterized by an episode of acute pain in theÂ middle to low thoracic or high lumbar regionÂ . Decrease in height and appearance of a dowager’s hump are reliable indicators of the early progress of the disease. Also, the patient often reports early satiety and a bloated feeling after eating only a small amount of food.Â

A bone mineral density (BMD) test is the only way to diagnose osteoporosis and determine an individual’s risk for future fracture.Â It measures the density of the bones (bone mass) and will indicate whether medication is needed to help maintain bone mass, prevent further bone loss and reduce fracture risk. The BMD test is accurate, painless and noninvasive. It is also possible to determine the rate of bone loss and/or monitor the effects of treatment if tests are conducted at intervals of a year or more.

Criteria approved for BMD tests are summarized below:

	estrogen-deficient women at clinical risk of osteoporosis.
	vertebrate abnormalities on x-ray suggestive of osteoporosis (osteopenia, vertebral fracture)
	primary hyperparathyroidism – abnormal function of the parathyroid glands itself which result in high level of blood calcium.
	monitoring response to an FDA-approved medication for osteoporosis.

For an uncomplicated patient with osteoporosis, aÂ laboratory work-upÂ may be recommended in addition to a BMD test.Â

Based onÂ four examination techniques, TCM practitioners will diagnosis osteoporosis according to its clinical symptoms and further characterize it by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have.Â

The common disharmony patterns of osteoporosis are:

1.	Yin deficiency of the liver and kidneys
Â	When the body perceives that it is inadequate in bone marrow, theÂ liverÂ andÂ kidneyÂ will hyper-function to compensate. This results in a relativeÂ yin deficiencyÂ inside the body.Â Virtual “fire”Â is produced and presents as heat symptoms. On examination, the tongue is red with a scanty thin fur coating. The pulse feels thready and rapid.
2.	Blood deficiency and excessive dampness
Â	Improper functions of theÂ spleenÂ andÂ stomachÂ lead to a decline in the production of blood and bone marrow, plus an accumulation of dampness. It gives rise to a non-smooth flow ofÂ bloodÂ andÂ qi, which in turn supply inadequate nutrients to the bones. People may feel weakness, back pain or joint pain. On examination, the tongue is pale and covered with greasy fur. The pulse sign is deep and rolling.
3.	Retention of dampness and kidney deficiency
Â	The kidneys govern water, produce marrow, dominate the bones and manufacture blood. The kidney yang energy is the source of all heat in the body. Kidney deficiency occurs when cold and dampness evils damage the kidneys. This results in inadequateÂ kidney essence (jing)Â to supply the bone marrow and causes deterioration of the bones. Symptoms can manifest as back pain and hump back. On examination, the tongue is pale and covered with white greasy fur. The pulse feels deep, thready and stringy.
4.	Asthenia-syndrome of superficiesÂ and interior dampness retention
Â	This is a morbid condition resulting from the exposure toÂ exogenous pathogensÂ in a person whose organs, like the spleen and stomach, are in a hypo-functioning state. When the body accumulates lot of evils (most likely dampness and coldness), stagnation of qi flow in the meridians and the joints occurs and results in impairment of organ and bones, which leads to symptoms of sluggishness, tired and heavy limbs, and joint pain. On examination, the tongue has a white coating. The pulse sign is deep and rolling.
5.	Cold in the superficies and heat in the interior
Â	This morbid condition results from the wind and cold evils that accumulated in the superficial regions of body has invaded interiorly and transformed into heat evil. This process manifests as both heat and cold syndromes clinically. These syndromes cause kidney damage and lead to failure supply ofÂ kidney essence (jing)Â for bone growth. On examination, the tongue is red and covered with white greasy fur, or yellow-colored fur. The pulse feels thready, stringy and rapid.
6.	Marrow deficiency andÂ channel bi-syndrome
Â	When marrow is seriously exhausted, the body skeleton loses nutrients. The accumulated evils block the channels orÂ meridiansÂ that are the paths for transportation of nutrients and this accelerates the bone deterioration. The person presents with serious symptoms like severe bone or joint pain and bone distortion. On examination, the complexion may appear pale or dark in color. The tongue is dark red, and covered with white greasy fur. The pulse feels deep and stringy.

Treatment

A blend of Western and TCM approaches can be of benefit in the treatment of osteoporosis. Often a combined treatment produces better outcomes than the exclusive use of one method. It is best to get the advice of a TCM practitioner who knows what is best for you and your condition. The treatments described below are some approaches that may be taken to treat the different TCM syndromes associated with osteoporosis.

1. Yin deficiency of liver and kidney

Therapeutic aim:NourishesÂ yinÂ forÂ kidneyÂ andÂ liver, replenishesÂ jingÂ and marrow.

Prescription:Â liuwei dihuang pellet with modification

gan di huang	dry rehmannia root
shan yu rou	Asiatic cornelian cherry fruit
huai shan yao	common yam root
fu ling	Indian bread
dan pi	tree peony bark
gou qi chi	Barbary wolfberry fruit
chuan duan	Himalayan teasel root

In this prescription, rehmannia, cornelian cherry and wolfberry are used to nourish the yin of the liver and kidneys; peony bark clears away heat evil and nourishes yin. Common yam and Indian bread invigorate the spleen and eliminate dampness evil; they also counteract the greasy properties of the other herbs. Teasel rootÂ tonifiesÂ the kidneys and strengthens tendons and bones.Â

2. Blood deficiency and excessive dampness

Therapeutic aim:Â Nourishes the blood and dispels dampness evils.Â

Prescription:Â Danggui Shaoyao powder plus additional supplement

dang gui	Chinese angelica
bai shao	white peony root
fu ling	Indian bread
bai zhu	large head atractylodes root
ze xie	oriental waterplantain rhizome
chuan xiong	Szechuan lovage root
fang ji	four stamen stephania root
gui zhi	cassia twig
gan jiang	dried ginger
gan cao	liquorice root

In the prescription, angelica, peony root and lovage root are used to activate blood circulation and nourish the blood. Cassia can remove obstruction in the meridians, activate blood circulation, and relieve joint pain. Indian bread, atractylodes root, waterplantain rhizome, and stephania root are used to invigorate the spleen and eliminate dampness evil. Ginger and liquorice root warm the middle burner and ease the stomach. Additionally, angelica, peony root, and lovage root can stimulate blood production. Indian bread, atractylodes root and cassia also eliminate the dampness evil and relax the tendons, as well as nourishing the tendons and bones.

3. Retention of dampness due to kidney deficiency

Therapeutic aim:Â Warms theÂ yangÂ and dispels dampness evils.Â

Prescription:Â zhenwu decoction plus additional supplementÂ

zhi fu pian	prepared common monkshood daughter root
bai shao	white peony root
sheng jiang	fresh ginger
fu ling	Indian bread
bai zhu	large head atractylodes root
gui zhi	cassia twig
bu gu zhi	malaytea scurfpea fruit
chuan duan	Himalayan teasel root
sang ji sheng	Chinese taxillus herb
xing ling pi	epimedium herb
ji xue teng	suberect spatholobus stem

In the prescription, monkshood and epimedium are used to warm the yang or the body. Ginger, Indian bread and atractylodes warm theÂ middle burnerÂ (spleen and stomach) and promote the secretion of urine. Peony root, cassia and spatholobus nourish the blood and remove obstruction in all the meridians. Scurfpea, teasel and taxillus nourish the kidney and strengthen the bones, loins, and legs.Â

4.Â Asthenia-syndrome of superficiesÂ with interior dampness retention

Therapeutic aim:Â Strengthens the middle burner, benefits theÂ qi, harmonizes nutrients and defends qi. It does this by providing a yang energy in the body derived from the digestion and absorption of foods by theÂ spleenÂ andÂ stomach. This helps protect the skin and muscle, provides resistance against theÂ exogenous pathogensÂ and regulates the secretion of sweat.

Prescription:fangyi huangqi decoction with modification

sheng huang qi	fresh milkvetch root
fang ji	four-stamen stephania root
sheng jiang	fresh ginger
da zao	Chinese date
gan cao	liquorice root
gui zhi	cassia twig
bai shao	white peony rooti
cang zhu	atractylodes root
sheng long ku	unprocessed fossil fragment
sheng mu li	fresh oyster shell

In the prescription, cassia, ginger, date, liquorice and milkvetch are used toÂ tonifyÂ the stomach, nourish the middle burner, and benefit the qi. Peony root nourishes the qi and regulates the blood circulation. Stephania and atractylodes eliminate dampness evil and relieve joint pain. Fossil and oyster shell arrest premature ejaculation and sweating. The synergistic action of the herbs in this recipe consolidate body resistance, eliminate fluid retention, replenish the kidney and blood, and nourish muscles and bones.Â

5. Cold in the superficies and heat in the interior

Therapeutic aim:Â Expels superficial pathogens and clears away heat evil.

Prescription:Â Yuebi Jiashu decoction with modification

ma huang	ephedra
cang zhu	atractylodes root
sheng jiang	fresh ginger
da zao	Chinese date
jiu gan cao	liquorice root
shang shi gao	unprocessed gypsum
fang ji	four-stamen stephania root
mu gua	papaya

In the prescription, ephedra, ginger, date and liquorice provide pungent and warming properties to warm the middle burner, invigorate the stomach, and relieve the exterior symptoms. Gypsum can clear away interior heat evil. Stephania, papaya, and atractylodes eliminate dampness evil and relieve joint pain.

6. Marrow deficiency andÂ channels bi-syndrome

Therapeutic aim:Â Nourishes the marrow and smoothes the flow of qi and blood in all meridians.

Prescription:Â yougui pellet with modification

shu di huang	processed rehmannia root
shan yao	common yam root
shan zhu yu	Asiatic cornelian cherry fruit
gou qi chi	Barbary wolfberry fruit
jiu gan cao	liquorice root
du zhong	eucommia bark
rou gui	cassia bark
zhi fu zi	prepared common monkshood daughter root
wu she	black snake
xing ling pi	epimedium herb
cang zhu	atractylodes root
gou ji	cibot rhizome
sang ji sheng	Chinese taxillus herb

In the prescription, monkshood, rehmannia, cassia, cornelian cherry, eucommia, cibot and epimedium invigorate the kidneys and strengthen the tendons and bones. Atractylodes and taxillus eliminate dampness evil and relieve joint pain. Liquorice helps regulate stomach function and benefits vital qi (energy).

Myasthenia Gravis

acuherb — Fri, 30 Mar 2012 19:41:57 +0000

By Dr. Ken. Wang

Myasthenia gravis is a chronic disorder ofÂ neuromuscular junctionÂ function that causes muscles to become weak and to tire easily. The specific pattern of muscle involvement is often important to diagnosis.Â

The Brain and Nervous System

The central nervous system comprises the brain and spinal cord. Nerves are attached to the spinal cord and branch out to the entire body forming the peripheral nervous system. Nerve impulses can travel along each nerve in one direction only. One type of nerve (motor) carries signals from the brain to the legs, for example, and another (sensory) sends signals back from the legs to the brain.

Myasthenia gravis is an autoimmune disease that results in chronic defective transmission of nerve impulses to the muscles. The disease produces weakness and abnormally rapid fatigue of voluntary muscles. Symptoms improve after rest or medication. The disease usually presents between the ages of 10 and 50 years and women are affected more often than men in 200,000. It is an uncommon disease occurring in approximately one in 200,000 people.

Depending on the symptoms it produces, myasthenia gravis is placed in different traditional Chinese medicine (TCM) syndrome categories:

	When weakness of the limbs predominates, it is classified asÂ flacciditysyndrome. In TCM, this refers to a syndrome marked by weakness, limited movement and muscular atrophy (wasting) of the limbs, especially the lower limbs and results from lack of nourishment reaching the muscle tissue. This can be caused by consumption ofÂ body fluidÂ byÂ lung-heat, an overwhelming effect of dampness-heat evil, or weakness of theÂ liverÂ andÂ kidneysÂ leading to insufficiency ofÂ essenceÂ andÂ blood.
	If the main symptom is drooping of one or both eyelids, the syndrome is classified asÂ ptosis.
	In individuals presenting with weakness of the eye muscles and suffering from double vision, the syndrome is classified asÂ vision changes.
	Others classifications includeÂ drooping headÂ orÂ respiratory collapseÂ and relate to corresponding manifestations of the disease.

Causes

Myasthenia gravis has an overall incidence of about four cases per million. There is no racial or geographic predilection, and the disorder can occur at any age. However, there is an increased incidence in young women, especially in the third decade, and in older men in the seventh decade.

The disease is caused by theÂ autoimmuneÂ destruction of theÂ acetylcholineÂ receptors on the post-synaptic membrane of the muscle fiber. Immune complexes are deposited at the post-synaptic membranes causing interference with and later destruction of the acetylcholine receptor. The communication between the nerve impulses and muscle fibers is impaired or lost and muscle weakness results.

Click here to see structure of the Neuromuscular Junction

The process that initiates the immune response is unknown, but the thymus gland appears to be critical for both the autoimmune activation and the maintenance of the activated autoimmune state. Overgrowth of the thymus gland is found in 70 per cent of myasthenic patients below the age of 40 years. In 10 per cent of patients there is a tumor of the thymus gland and the incidence of this increases with age.

There is an association between myasthenia gravis andÂ thyroid disease,Â rheumatoid disease,Â pernicious anemiaÂ andÂ systemic lupus erythematosus. Myasthenia gravis is sometimes caused by D-penicillamine treatment in rheumatoid disease.

In TCM, myasthenia gravis is considered to be a complex disease. ManyÂ organsÂ or systems of the body are involved and progress of the disease varies. Manifestations of the disease do not necessarily follow a prescribed order, but depend on the pathogenic factors involved and the mechanisms affected. The causes can be classified as follows:

Exogenous causesÂ
Invasion byÂ exogenous pathogensÂ leads to impaired functioning of organs and depletion of blood andÂ vital energy (qi), contributing to the disease. TCM considers thatÂ bloodÂ belongs to yin-fluid, which is mainly responsible for providing moisture and nourishment to the tissues. The role of qi is to promote and consolidate all body functions. Deficiency in blood and qi result in inadequate supply of these essentials to the muscles, tendons and meridians and flaccidity syndrome results.

Endogenous causes
These can occur when an individual encounters emotional problems or damage by theÂ seven modes of emotionsÂ (for example, anger damaging theÂ liver, fear damaging theÂ kidneysÂ or melancholia damaging theÂ spleen). The understanding in TCM is that the liver stores the blood that supports the tendons, and the kidneys store essence for the production of bone marrow. Both blood andÂ essenceÂ are part of yin. If an individual’s liver-yin and kidney-yin are depleted, a virtual fire is created internally causing the supply of blood and essence to become exhausted. The tendons and muscles then lose their nutrient supply and become weak and numb.

Non-exogenous/endogenous cause
This is mainly the result of an imbalanced lifestyle and includes the eating of an improper diet (too much greasy or sweet food) or excess consumption of alcohol and leads to spleen and stomach injury. Stress and chronic disease can also result in a decline in qi andÂ body fluidÂ and cause spleen andÂ stomachÂ damage. The spleen and stomach are the primary organs for digestion and absorption; they extractÂ nutritive essenceÂ from food and use it for the production of qi, blood and body fluids. If they do not function properly, muscle weakness, drooping eyelids or breathing difficulties can develop.

Congenital factors
Inborn defects, such as weakness of the spleen and stomach,Â yang-deficiencyÂ of the spleen and kidneys orÂ yin-deficiencyÂ of the liver and kidneys, can cause failure in different organs and lead to the disease.

Symptoms

Weakness is the defining symptom of myasthenia gravis. Patients may not recognize it as such and complain to their doctor of double vision, difficulty swallowing, slurring of speech, or even a change in gait. Five areas of motor function are commonly affected and involve the muscles that control the following:

	the eye
	the face, nose and throat
	respiration
	the torso (pectoral and pelvic muscles), and
	the arms and legs.

The symptoms may fluctuate from hour to hour, from day to day, or over longer periods. They are provoked or worsened by exertion, exposure to extremes of temperature, viral or other infections, menses and excitement.Â

The symptoms experienced are commonly these:Â

	Eye muscle involvement often results in drooping of the upper eyelid and double vision. It usually affects both eyes and is asymmetrical.
	Weakness of other muscles innervated by cranial nerves results in loss of facial expression, everted (pouting) lips, a smile that resembles a snarl, jaw drop, nasal regurgitation of liquids, choking on foods and secretions, and a slurred, nasal speech with a reduced volume.
	Depending on the severity of the disease, difficulty breathing can appear on moderate or mild exertion or be present even at rest.
	Abnormal tiredness of the limb muscles causes difficulty in combing the hair, lifting objects repeatedly, climbing stairs, walking and running.

Initially, the symptoms affect only the eyes in 40 per cent of patients; are generalized in 40 per cent; involve only the extremities in 10 per cent; and affect only the nose, mouth or throat, or these muscles and the eye muscles in another 10 per cent. Subsequently, the weakness can spread from the eye to the facial, salivary, swallowing and respiratory muscles and then to the torso and limb muscles, but the sequence may vary. Arm and leg muscles are affected more than hands and feet. In the most advanced cases the weakness is general throughout the body.

By the end of the first year, the eye muscles are affected in nearly all patients. The symptoms remain ocular (involving the eye) in only 16 per cent. In nearly 90 per cent of those in whom the disease becomes generalized, this occurs within the first year after the onset. Progression is most rapid within the first three years, and more than half of the deaths caused by myasthenia gravis occur in that period.

SpontaneousÂ remissionsÂ lasting from weeks to years can occur. Long remissions are uncommon, and most remissions occur during the first three years.

TCM practitioners will examine a sufferer and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. In myasthenia gravis, these can be classified into the following types:

Qi-deficiency in theÂ spleenÂ andÂ stomach
Individuals present with drooping eyelids, weakness of the limbs, and difficulty in holding the head up and chewing food. Symptoms are worse towards the end of the day. Others symptoms include poor appetite, diarrhea, a reluctance to speak and shortness of breath.

Yang-deficiency in the spleen andÂ kidneys
This often presents with drooping eyelids, limitation in muscular control of the eye, and limb weakness. Other accompanying symptoms are soreness in the loin region, spontaneous sweating, aversion to cold temperatures, cold limbs, a pale complexion, difficulty in swallowing, poor appetite and diarrhea, and the excretion of large volumes of dilute urine.

Yin-deficiencyÂ in theÂ liverÂ and kidneys
The main symptoms include drooping eyelids, difficulty in swallowing and chewing food, and limb weakness. Symptoms worsen towards the end of the day. Other accompanying symptoms are soreness and weakness in the lumbar (lower back) region and knees, dizziness, ringing in the ears, insomnia and nightmares. A feeling of dryness in both eyes and a hot sensation in the chest, palms of the hands and soles of the feet can develop.

Deficiency in bothÂ qiÂ andÂ blood
Individuals present with fatigue and weakness, palpitation, shortness of breath, a reluctance to speak, pale complexion, drooping eyelids, difficulty in swallowing and chewing food, muscle wasting and fatigue, and spontaneous sweating.Â

Diagnosis

The presence of weakness (usually worse at the end of the day or after vigorous exercise), but without loss of sensation is necessary although not sufficient on its own to make the diagnosis of myasthenia gravis. Diagnosis is based on the clinical history, physical examination and results of specific tests and laboratory studies.Â

Tensilon (edrophonium) test
Edrophonium chloride (anÂ anticholinesterase) is given intravenously. If improvement in weakness occurs within seconds and lasts for two to three minutes the test is considered positive. Occasionally the test itself can cause respiratory constriction and fainting and is always carried out in a proper clinical setting.

Serum acetylcholine receptor antibodies
These disease-specific antibodies are present in 90 per cent of cases of generalized myasthenia gravis. The antibodies are found in no other condition.

Nerve stimulation
Stimulation of the motor nerve results in a characteristic decrease in muscle response.

Other tests
Chest X-ray may show a mass (enlarged gland) in the area of the thymus that can be confirmed by computed tomography scanning. Nothing unusual can be detected from peripheral blood samples.

1.	QuestioningÂ The TCM practitioner will establish the medical history of both the patient and his family.
2.	ObservationÂ Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
3.	Listening and smellingÂ The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4.	TouchingÂ Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In myasthenia gravis, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:Â

Qi-deficiency in theÂ spleenÂ andÂ stomach
Impaired functioning of the spleen and stomach causes an insufficiency inÂ qiÂ andÂ bloodÂ production. This reduces the supply of nutrients available to the muscles and tendons and results in weakness in muscular contractions. A reluctance to speak and shortness of breath also result from qi and blood insufficiency. Poor appetite and diarrhea are symptoms of spleen weakness.

On examination, the tongue is swollen, pink in color, indented on the margins and coated with a thin, white fur. The pulse is weak and fine.

Yang-deficiency in the spleen andÂ kidneys
Yang-deficiency implies under-functioning of these two organs. This leads to a decline in the storage ofÂ essenceÂ and muscle weakness results. Kidney-yang deficiency also causes soreness in the loin area, production of copious amounts of dilute urine and an aversion to cold temperatures.

On examination, the tongue is swollen, pink in color and covered with a thin, white fur. The pulse is deep and fine.

Yin-deficiency in theÂ liverÂ and kidneys
Yin-deficiency of these organs leads to essence and blood depletion and results in loss of nourishment and moisture to the body. Body structures, such as the muscles, bones and tendons, become weak. Liver-yin deficiencyÂ can also cause insomnia, nightmares and dryness of the eyes. Kidney problems cause dizziness, ringing in the ears, soreness and weakness in the loin area and the knees.

On examination, the tongue is red with a scanty fur covering. The pulse is fine and rapid.

Deficiency in both qi and blood
Deficiency in qi and blood not only affects the supply of nutrients to muscles and tendons, but also leads to general impairment of the whole body. In addition to symptoms of muscle weakness, individuals present with fatigue, palpitation, shortness of breath, pallor and spontaneous sweating.

On examination, the tongue is pale, swollen and indented on the margins. The tongue fur is white and thin. The pulse is deep and fine.

Treatment

There are three therapeutic options in the TCM treatment of myasthenia gravis: the regularization of disharmony patterns, use of Chinese patent medicines and acupuncture therapy.

Therapeutic regimens for disharmony patterns

Qi-deficiency in the spleen and stomach

Therapeutic aim:Â ToÂ TonifyÂ theÂ spleenÂ and benefit theÂ qi

Prescription:Â Buzhong yiqi decoction (modified)

dang shen	pilose asiabell root
huang qi	milk-vetch root
bai zhi	large head atractylodes root
sheng ma	cimicifuga rhizome
chai hu	Chinese thorowax root
chen pi	dried tangerine peel
dang gui	Chinese angelica
sheng jiang	fresh ginger
da zao	Chinese date
yi yi ren	coix seed
fu ling	Indian bread

In this prescription, pilose asiabell, milk-vetch and large head atractylodes roots are used to tonify the spleen and benefit the qi. Cimicifuga rhizome and Chinese thorowax root improve the transformation and transportation functions in the spleen. Dried tangerine peel regulates the qi movement; Chinese angelica aids the blood; and fresh ginger and Chinese date improve the communication between the interior and exterior of the body. Coix seed and Indian bread invigorate the spleen and expelÂ dampness evil. Used in combination, these ingredients invigorate the spleen andÂ stomach, increasing production ofÂ nutrient essenceÂ and relieving symptoms.

Yang-deficiency in the spleen andÂ kidneys

Therapeutic aim:Â To warm and tonify the spleen and kidneys

Prescription:Â Yougui bolus (modified)

fu zi	monkshood
rou gui	cassia bark
lu jiao jiao	deerhorn glue
shu di	processed rehmannia root
shan yu rou	Asiatic cornelian cherry
tu si zi	dodder seed
gou qi chi	Chinese wolfberry fruit
du zhong	eucommia
dang gui	Chinese angelica
dang shen	pilose asiabell root
huang qi	milk-vetch root
shan yao	common yam root
bai zhi	large head atractylodes root

In this prescription, monkshood, cassia bark and deerhorn glue warm and invigorate the spleen and kidneys. Rehmannia root, Asiatic cornelian cherry, dodder seed, wolfberry and eucommia are used for nourishing the spleen-yinÂ and kidney-yin. Chinese angelica replenishes the blood; and pilose asiabell, milk-vetch, common yam and large head atractylodes roots replenish the qi and tonify the spleen.

Yin-deficiency in the liver and kidneys

Therapeutic aim:Â To nourish and invigorate theÂ liverÂ and kidneys

Prescription:Â Zuogui bolus (modified)

sheng di	fresh rehmannia rhizome
gou qi chi	Chinese wolfberry fruit
shan yu rou	Asiatic cornelian cherry
lu jiao jiao	deerhorn glue
gui jiao	tortoise shell glue
tu si zi	dodder seed
niu xi	achyranthes root
shan yao	common yam root

In this prescription, fresh rehmannia rhizome is used in quantity for effective nourishment of the kidney-yin. Wolfberry replenishes the essence and improves visual acuity; and Asiatic cornelian reduces depletion of essence and calms the liver. Deerhorn glue invigorates theÂ yang; and tortoise shell glue nourishes the yin. A combination of these two glues can replenishÂ essenceÂ and bone marrow. Dodder seed and achyranthes root reinforce the lumbar (lower back) region and knees, and strengthen the tendons and bones. Common yam root tonifies the spleen and aids the kidneys.

Deficiency in both qi and blood

Therapeutic aim:Â To invigorate and replenish the qi and bloodÂ

Prescription:Â Bazhen decoction (modified)

ren shen	ginseng
fu ling	Indian bread
bai zhi	large head atractylodes root
gan cao	liquorice root
dang shen	pilose asiabell root
bai shao	white peony root
shu di	processed rehmannia root
chuan xiong	Szechwan lovage root
sheng jiang	fresh ginger
da zao	Chinese date

In this prescription, ginseng, Indian bread, large head atractylodes root and liquorice root invigorate the spleen and benefit the qi. Pilose asiabell, white peony and rehmannia roots nourish theÂ heartÂ andÂ blood. Szechwan lovage root improves the blood circulation; when combined with pilose asiabell root and rehmannia root, it increases blood production without causing an increase in viscosity (thickening). Fresh ginger and Chinese date help the ginseng and Indian bread to regulate the spleen and kidneys.

Chinese patent drugs
These drugs are available in small dosages and are readily absorbed on ingestion. They are more convenient to use because they are not bulky to carry about and are therefore more appropriate to a busy lifestyle. Taking a pill or a bolus is often easier for those who do not wish to consume large volumes of liquid or who do not like the bitter taste of decoctions. Examples of patent medicines used in the treatment of myasthenia gravis are:

Qi-deficiency in the spleen and stomach:Buzhong yiqi bolus
Yang-deficiency in the spleen and kidneys:Ginseng yangrong bolus
Yin-deficiency in the liver and kidneys:Liuwei dihuang bolusÂ
Deficiency in both qi and blood:Â
Jinkui shenqi bolus

Acupuncture therapies
Use of acupuncture stimulates theÂ meridians. These connect the internalÂ organsÂ with the limbs and their stimulation results in:Â

	activation of qi and blood
	regulation ofÂ yin and yang
	strengthening of the tendons and bones, and
	lubrication of the joints.

Acupuncture can be used therefore as the main or an adjuvant therapy.Â
Treatment is given daily over 10 days; four to five acupoints are selected each time andÂ the needle retainedÂ for 20 to 30 minutes.

	For drooping eyelids, acupoints are selected on the face: zan-zhu, yang-bai, yu-yao, si-bai and jing-ming.
	For limb weakness: he-gu, nei-guan, wai-guan, san-yin-jiao, tai-chong, da-zhui, pi-yu, shen-yu and zu-san-li are used.

Otopuncture therapyÂ
This therapy is used weekly and applied to each ear alternately. The method involves acupoint embedding of the needle under the skin.

The acupoints used are spleen, kidney, liver and points for endocrine functions.Â

Lung Cancer

acuherb — Wed, 28 Mar 2012 17:44:30 +0000

By Dr. Ken. Â Wang

Lung cancer is the most comm only fatal of all cancers, killing more than half a million people worldwide every year. A majority of lung cancers are linked to tobacco use. As this habit becomes more prevalent, lung cancer numbers rise. It is the leadingÂ fatalÂ cancer among adult males and is rapidly increasing in women, as more and more take up smoking.

Lung cancer develops when lung cells change into abnormal cancer cells after being continually irritated by something in their environment, known as a carcinogen. The most common lung carcinogens are the toxins in cigarette smoke, to which both smokers and those breathing other people’s secondhand smoke are exposed. The Cancer Society of New Zealand reports that second-hand smoke is the third largest killer in the country, after active smoking and alcohol use. Industrial chemicals and dusts can also act as carcinogens and contribute to the development of lung cancer.Â

Cancer cells are cells able to divide very rapidly and do not follow the regular patterns of normal healthy cells. They form colonies or tumours of tissue that do not help the lungs to function normally. Some cancer cells break off and travel in the blood to different parts of the body to form new cancer colonies known as “metastases.” When these cancer colonies grow so large that they interfere with normal lung function or the healthy functioning of other parts of the body, symptoms like pain, bleeding, loss of function (i.e. difficulty breathing), and /or weight loss may appear.Â

Types of Lung CancerÂ
Lung cancers are grouped according to the type of cells they contain. Because each cancer cell type behaves differently, selected treatment will also be different.Â

	Squamous cell carcinomaÂ is the most common type of lung cancer (30 percent of cases) and is almost always associated with tobacco smoking. It develops in the lung cells lining the main bronchi (the largest air passages). This tumour often grows out into the airway and blocks it, leading to symptoms like breathlessness, chronic cough, and bloodstained (rusty) sputum. It usually spreads into the chest wall and local lymph nodes before metastasizing (sending cancerous cells to distant parts of the body). When this happens, it may be discovered and diagnosed early enough for effective surgical removal.
Â	Â
	AdenocarcinomaÂ is the form of lung cancer most commonly found in non-smokers and accounts for 29 percent of all lung cancers. There is a high rate of this kind of cancer among non-smoking Hong Kong women. It develops in the glands supplying the lungs with mucous of the airways and is often found in the outer areas of the lung.
Â	Â
	Small cell carcinoma, another common cancer, (17 percent of lung cancer cases), is also strongly linked to cigarette smoking. This type is sometimes referred to as oat cell carcinoma because the cancer cells look oat-shaped. Small cell carcinoma can cause a rapid early death because it spreads or metastasizes quickly and is “silent,” meaning it does not have early warning symptoms.
Â	Â
	Large cell carcinomaÂ is responsible for 15 percent of lung cancer cases. It has large, rounded cells and grows in the airways eventually making it difficult to breathe.
Â	Â
	Bronchioloalveolar cell carcinomaÂ is a rare tumour found in less than two percent of cases.
Â	Â
	Unknown cell types:Â Nine percent of tumours contain cancer cells which pathologists cannot identify or classify either because the cells are “mixed” (containing a range of different types of cells), undifferentiated (do not have characteristics belonging to any particular cell line) or come from another part of the body.
Â	Â
	MesotheliomaÂ is not always classified as lung cancer because it develops in the membranes (pleura) covering the lung and the inside of the chest walls. A rare tumour, mesothelioma is strongly linked with exposure to asbestos. This is the reason asbestos is now considered to be a very dangerous material.

According to Traditional Chinese Medicine (TCM) theory, lung cancer is included under the categories describing “lung-masses”, “expanding-masses”, “cough”, “cough blood” and “chest pain”. Several ancient medical books make reference to it. For example, in the book “Summary from the Golden ChestÂ ” (Han Dynasty 206-220AD) under the five organs section, it states “the [lung] mass cannot be easily removed.” In theÂ Huang Di Nei Jing Su WenÂ , another famous book written during the Han dynasty, it refers to “difficulty breathing [with lung cancer] without having difficulty eating.” TCM believes lung cancer results from having a lack of healthy energy and from the accumulation of exogenous evils (outside influences that invade the body and cause illness).

Causes

Retention of Wetness and Phlegm evilÂ Hypofunction (under functioning) of the Â spleenÂ causes a disturbance in body-fluid metabolism and failure of fluid transportation, which are part of this organ’s main functions in TCM. Untransformed body fluid turns into phlegm and wetness, which are toxic materials. These toxic materials flow upward and interfere lung function.Â

Stagnation of Vital EnergyÂ
Under normal conditions, the vital energyÂ (qi)Â circulates smoothly in and out, up and down and all over the body. If an internal injury occurred, for example, depression of the seven emotions will cause deficiency and impairment of vital qi and derangement ofÂ yin and yang, it may cause breathing syndromes due to the improper lung function. TCM believes yin and yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportions of yin and yang are unequal and unbalanced. When one aspect is deficient, the other is in excess. Lung cancer is induced by an overall deficiency of qi and yin in the body, which leads to an excess syndrome in the lungs. The excess syndrome generally manifests as pathological lung changes such as a stagnation of qi flow, blood stasis (lack of easy blood flow) and accumulation of phlegm and toxins.

Blood Stasis
Vital energy (qi) acts as the commander of blood. It means that vital energy is the motivating force of the blood circulation. Therefore blood stasis is usually accompanied by stagnation of vital energy. Coagulation and stagnation of qi and blood flow can contribute to the formation of a tumour.Â

Pathogenic evils (substances causing disease) invade the lungÂ
When the healthy energy is deficient due to body dysfunction or structural damage. Some pathogenic evils such as wind and cold take advantage of this imbalance and invade the lung. Over time these evils accumulate in the lungs and can cause cancer.

How do these factors contribute to the development of lung cancer?Â
As a result of lung dysfunction and improper qi flow, body fluids cannot be properly distributed. They begin to accumulate in the lungs and eventually turn into phlegm. Over time, the phlegm, stagnant blood and qi flow, and the remaining toxins trapped in the lungs form into a lump, which would be known in western medicine as a lung cancer mass.Â

Other Factors Associated with the Development of Lung Cancer:

1.	Smoking
2.	Occupational Exposure to Carcinogens (substances that can cause cancer) i.e. inorganic arsenic, asbestos, chrome, nickel, radon, hydrocarbon in coal smoke, coal tar, and fossil oil
3.	Air pollution
4.	Ionizing Radiation
5.	Diet and Nutrition

Symptoms

Lung cancer can be divided into 5 different syndromes. The symptoms will differ depending on the syndrome each individual has.

1. Yin Deficiency and Interior Heat SyndromeÂ
Symptoms include a cough without sputum or a cough with thick sputum. The sputum can appear blood stained. Breathlessness, chest pain, a dry mouth and throat, a hoarse voice, mild fever and night sweats may also be present. Individuals may feel distracted or have insomnia. The tongue appears flushed or dark red and has a little or no coating. The pulse feels rapid and thready.

2. Spleen Deficiency and Phlegm Dampness SyndromeÂ
Symptoms include a cough that produces a lot of sputum and chest tightness accompanied by shortness of breath. These individuals usually feel weak and fatigued and have pale complexions. Weight loss and loose stools are also common. Their tongues appear pale and bulging and have an indented margin. A white and greasy fur coating may also be present. The pulse feels soft and moderate or soft and rolling.

3. Deficiency of Qi and Yin SyndromeÂ
Symptoms include a low and weak sounding cough, which produces a small amount of sputum, which can be bloodstained. These individuals can experience shortness of breath, fatigue and weakness. They are thirsty but lack the desire to drink and may sweat spontaneously or have night sweating. The tongue appears light red or red with an indented margin, and the pulse feels thready and weak.

4. Deficiency of Yin and Yang SyndromeÂ
Respiratory symptoms include a cough, shortness of breath, dyspnea (difficulty breathing) and/or tachypnea (rapid breathing) with exercise. Tinnitus (ringing in the ears), body aches, lower back (lumbar) or knee weakness, urinary frequency at night may also be present. Individuals can have an aversion to cold and have cold limbs. General fatigue and weakness are also not uncommon. The tongue appears light or dark red with a thin fur coating, and the pulse feels deep and faint.

5. Stagnation of Qi and Blood Stasis SyndromeÂ
Symptoms include difficulty coughing and expectorating bloodstained sputum, chest tightness, tachypnea (rapid breathing), chest pain and distension and abdomen pain located in a fixed position. Purple veins show on the neck and chest. Lips and nails are dark coloured. Constipation with dry and hard stools may also be present. The tongue appears dark red and may have either ecchymosis (bruise) or petechiae (pinpoint bruises) with a yellowish thin coating. The pulse will feel taut or uneven.Â

Diagnosis

Development of lung cancer comes from a weakening of the healthy energy that flows through the body. As previously stated, this mainly occurs when there is a deficiency of vitalÂ qiÂ and imbalance ofÂ yin and yang. It manifests itself as one of the five syndromes previously described under the “symptoms” section.

Diagnosis in TCM is based on four important examination techniques. The first is “questioning.” The TCM practitioner will want to know important information such as what your current complaints are, your past medical history, and family health history. The second technique is “observation.” Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest are important when evaluating lung cancer. The last technique used in examination includes “touching.” Feeling the pulse is one of the cornerstones of TCM diagnosis and gives the TCM practitioner a lot of information about the imbalance occurring in the body.

If the TCM practitioner, suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she may recommend that the individual see a western doctor for further follow up. It is also not uncommon for a TCM practitioner to ask to see the blood work or x-rays that you have had performed to give the practitioner more information when forming a TCM diagnosis. The syndromes that are most commonly diagnosed with lung cancer include:Â

1.	Yin Deficiency and Interior Heat Syndrome
2.	Spleen Deficiency and Phlegm Dampness Syndrome
3.	Deficiency of Qi and Yin Syndrome
4.	Deficiency of Yin and Yang Syndrome
5.	Stagnation of Qi and Blood Stasis Syndrome

When evaluating someone for lung cancer, it is important to make sure that it can be differentiated from the following health problems.

PneumoniaÂ
This is an acute and febrile disease which is caused by a wind-heat pathogen (substance causing a disease). According to TCM, it develops in four stages: the defense (wei) stage, vital energy (qi) stage, nutrient (yin) stage, and blood (xue) stage. At the beginning there will be a fever and cough which are the defenses against the pathogens. As chest pain, coughing, and yellow thick sputum develop, the pneumonia goes into the qi stage. When the pathogens interfere with the body receiving nutrients, the pneumonia enters the nutrient stage, and symptoms such as a high fever or convulsions may occur. Finally, when the pathogenic factors enter the blood, lethargy, coma and even death may occur if it is not treated properly.Â

Lung abscess
It is usually caused by a pathogen that originates form outside of the body and also has an acute onset. Symptoms like sudden chilling, high fever, chest pain, increased sputum production with a fishy smell or thick bloodstained sputum, and a cough are usually present.Â

Lung tuberculosisÂ
It is caused by weakness, a deficiency of qi and blood, and the bacteria Mycobacterium tuberculosis. Its main active manifestations are a chronic cough, heamoptysis (coughing up blood or bloody sputum), fever, night sweating, fatigue and weight loss.Â

Treatment

Treatment of lung cancer is complex and can benefit from a complementary western and TCM approach. Often the combined treatment of western medicine and TCM produces better outcomes than using either method alone.

A lot of traditional TCM treatments increase the body’s resistance to invading pathogens (substances that cause disease) in order in to increase a person’s lifespan. TCM treatments aim to relieve symptoms, stop the disease’s progression and restore healthy functioning of the individual rather than curing (in the western sense) a disease completely. While herbs are commonly used, other methods of treatment may include acupuncture, meditation and qi gong.

Recently, with the advances in western research techniques, there has been a lot of research into anticancer mechanisms of Chinese herbs. Studies have shown that certain TCM herbs can work in the following ways to help slow down or stop the progression of cancer by:Â

1.	Inducing the cancer cell to differentiate into a normal cell.
2..	Promoting apoptosis of cancer cells. Apoptosis, also sometimes called programmed cell death, means that a chemical signal is triggered within the cell telling it to die. In cancer cells this chemical signal seems to be turned off, which is why they multiply rapidly.
3.	Helping to block the chemical messages in cancer cells that tell them to grow, multiply and form into tumours.
4.	Improving the efficacy of chemotherapy. Currently many cancers are developing drug resistance to chemotherapy regimens because of their high expression of P-polysaccharides(PGP). Some TCM herbs can interfere with this expression or offer new ways to attack cancer cells.
5.	Activating blood circulation and eliminating blood stasis. It is thought better blood circulation can limit the tumour spread and allow chemotherapy to reach the cancer cells more effectively.
6.	Supporting the body’s own immune system by activating macrophages, increasing antibody production, and regulating lymphocytes so it can fight cancer cells more efficiently and limit the growth of the tumor. Some mushrooms such as yunzhi (Coriolus versicolor) and lingzhi (Ganoderma lucidum) are known for their ability to support healthy immune system function.
7.	Killing the cancer cells directly.

Because there are many, TCM prescriptions and products that may possess one or more of the above properties, it is best to get the advice of a TCM practitioner who knows what’s best for you and your condition.Â

The treatments described below are some approaches that may be taken to treat the different TCM syndromes associated with lung cancer.Â

1. Yin Deficiency and Interior Heat Syndrome
Therapeutic aim: Nourish yin and clear away lung-heat, soften the hard mass found in the chest and remove toxins from the body.Â

Prescription: Yangyin Qingfei Xiaojie Tang Jiajian Decoction.

Nanshashen	Fourleaf Ladybell Root
Beishashen	Coastal Glehnia Root
Tiandong	Cochinchinese Asparagus Root
Maidong	Dwarf Lilyturf Tuber
Baihe	Lily Bulb
Xingren	Almond
Baibu	Stemona Root
Yuxingcao	Heartleaf Houtuynia Herb
Shengyiren	Raw Coix Seed
Quangualou	Whole Snakegourd Fruit
Bayuezha	Akebia fruit
Shishangbai	Selaginella Herb
Shijianchuan	Chinese Sage Herb
Baihausheshecao	Hedyotis Diffusa Herb
Chanpi	Dry skin of Toad
Xiakucao	Spike of Prunella
Shenmuli	Raw Oyster Shell

Addition for individuals with sputum mixed with blood:Â

Xianhecao	Hairyvein Agrimonia Herb
Baimaogen	Lalang Grass Rhizome

Addition for individuals with low grade fever:Â

Yinchaihu	Starwort Root
Digupi	Chinese Wolfberry Root-bark

Addition for individuals with insomnia:Â

Zaoren	Date Seed
Hehuanpi	Silktree Albizia Bark
YeJiaoteng	Fleece-flower Stem

Addition for individuals with night sweating:

Rudaogen	Glutinous Root
Fuxiaomai	Blightened Wheat

2. Spleen Deficiency and Phlegm Dampness SyndromeÂ
Therapeutic aim: Replenish qi and invigorate the spleen, disperse lung-qi and help break up and expel phlegm.Â

Dangshen	Tangshen
Baizhu	Largehead Atractylodes Rhizome
Fuling	Indian Bread
Chenpi	Dried Tangerine Peel
Banxia	Pinellia Tuber
Xingren	Almond
ShengnanXing	Rhizome of Arisaema
Shanhailuo	Codonopsitis Root
Shishangbai	Selaginella Herb
Shijianchuan	Chinese Sage Herb
Yiren	Coix Seed
Ziwan	Tatarian Aster Root
Kuandong	Common Coltsfoot
Jiaoshanzha	Hawthorn Fruit (charred)
Jiaoshenqu	Leavened mixture of almond, sweet wormwood herb etc.(charred)

Addition for individuals with an abundant expectoration of sputum

Baijiezi	Seed of Sinapis Alba
Tianjiangke	Shell of Metaplexis fruit

Addition for individuals with loose stool and cold limbs

Buguzhi	Malaytea Scurfpea Fruit
Huluba	Common Fenugreek Seed
Tusizi	Dodder Seed

3. Deficiency of Qi and Yin SyndromeÂ
Therapeutic aim: Supplement qi, nourish yin, break up and expel phlegm and remove toxic substances from the body.

Prescription: Combination decoction of Sijunzi Tang and Shashen Maidong Tang Jiajian

Huangqi	Raw Milkvetch Root
Baizhu	Raw Largehead Atractylodes Rhizome
Beishashen	Coastal Glehnia Root
Tiandong	Cochinchinese Asparagus Root
Maidong	Dwarf Lilyturf Tuber
Wuweizi	Chinese Magnoliavine Fruit
Xingren	Almond
Baibu	Stemona Root
Gualoupi	Snakegourd Fruit peel
ShengnanXing	Rhizome of Arisaema
Shijianchuan	Chinese Sage Herb
Baihausheshecao	Hedyotis Diffusa Herb
Xiakucao	Spike of Prunella
Shengmuli	Raw Oyster Shell
Chuanbeimu	Tendrilleaf Fritilary Bulb

Addition for individuals with yellow sputum

Huangqin	Baical Skullcap Root
Sangbaipi	White Mulbery Root-bark
Yeqiaomaigen	Wild Buckwheat Root

Addition for individuals with more yin deficiencyÂ

Xiyangshen	American Ginseng
Nuzhenzi	Glossy Privet Fruit

Addition for individuals with more Qi deficiency

Shengshaishen	Sun-dried ginseng
Taizishen	Heterophylly Falsestarwort Root

4. Deficiency of Yin and Yang Syndrome
Therapeutic aim: Nourish yin, warm the kidney, subdue swelling and dissolve lumps or masses.Â

Prescription: Shashen Maidong Tang Decoction and Zan Yu Dan (fertility promoting pill)Â

Beishashen	Coastal Glehnia Root
Tiandong	Cochinchinese Asparagus Root
Shengdi	Rehmannia Root (unprocessed)
Xianmao	Common Curculigo Rhizome
Xianlingbi	Epimeddium
Congrong	Cistanche Deserticola Stem
Chuanbeimu	Tendrilleaf Fritilary Bulb
Shoudi	Rehmannia Root (processed)
Shandougen	Vietnamese Sophora Root
Shishangbai	Selaginella Herb
Huangbuliuxing	Cowherb seed
Shijianchuan	Chinese Sage Herb
Furongye	Cottonrose Hibicus leaf
Xueliguo	Climbing Fig Fruit

Addition for individuals with an aversion to cold and who have cold limbsÂ

Fuzi	Prepared Common Monkshood Daughter Root

Addition for individuals with frequent urination at night

Yizhiyen

Sharpleaf Glangal Fruit Seed

Addition for individuals with difficult and fast breathing

Shengesan	Powder of Ginseng and Gecko
Zishiying	Fluorite
Tusizi	Dodder Seed

5. Stagnation of Qi and Blood Stasis Syndrome
Therapeutic aim: Replenish Qi to resolve blood stasis, soften hard mass and dissolve lumps or masses.

Prescription: Fuyuan Huoxue Tang Jiajian Decoction (for recuperation and promoting blood circulation)

Taoyen	Peach seed
Huangbuliuxing	Cowherb seed
Danshen	Danshen Root
Sanleng	Common Burreed Tuber
Ezhu	Zedoray Rhizome
fengfang	Honeycomb
Bayuezha	Akebia fruit
Chuanyujin	Curcuma stem
Quangualou	Whole Snakegourd Fruit
Shengbiejia	Raw Turtle Shell
Xiakucao	Spike of Prunella
Haizao	Seaweed
Kunbu	Tangle
Shandougen	Vietnamese Sophora Root
Shijianchuan	Chinese Sage Herb
Baihausheshecao	Hedyotis Diffusa Herb
Shancigu	Common Pleione Pseudobulb
Shengmuli	Raw Oyster Shell

For individuals with bloodstained sputumÂ

Deduct:
Taoyen	Peach seed
Danshen	Danshen root
Huangbuliuxing	Cowherb seed

And Add:
Xianhecao	Hairyvein Agrimonia Herb
Qiancaogen	India Madder Root
Shensanqi	Radix Notoginseng

Addition for individuals with a puffy face and headÂ

ShengHuangqi	Raw Milkvetch Root
Fangji	Fourstamen Stephania Root
Cheqianzi	Plantain Seed

Addition for individuals with severe pain

Yanhu	Yanhu
Ruxiang	Frankincense
Moyao	Myrrh
Xuchangqing	Paniculate Swallowwort Root

Contact Dermatitis

acuherb — Thu, 29 Dec 2011 20:15:20 +0000

Contact dermatitis

Contact dermatitisÂ describes an acute inflammatory condition of the skin or mucosa that results from contact with certain irritant substances or stimulants. The condition occurs in all ages and both sexes, but there is a higher incidence in children than the elderly and women are more commonly affected than men. A characteristic of the disease is a history of exposure to allergenic substances prior to the inflammatory episode. Such substances or stimulants can include medicated plasters, ointment, lacquer, plants, certain materials used in clothing and contact with animals. The distribution of the lesions on the skin corresponds to the points of contact with the irritant and is largely limited to those areas.

The disease has an acute onset. Typical symptoms include itchiness, a burning sensation, and swelling and tenderness of the lesions. Systemic involvement can occur in severe cases. Once irritants are removed and proper treatment given, the condition will usually resolve within one to two weeks. However, further exposure to the causative agent will cause a re-occurrence.

In traditional Chinese medicine (TCM) contact dermatitis is not recognized as a disease as such, but as a collection of symptoms. From a TCM viewpoint, diseases of the skin are included in the category of surgical trauma and they are described in many ancient surgical classics. As there is no general term in TCM for contact dermatitis, the condition is referred to by names which describe both symptoms and causative agent. Examples of these include:Â

	“lacquer sore”
	“plaster rubella” from Chinese herbal poultices
Â	Â
	“commode ringworm” (inflammation of the buttocks caused by newly lacquered, old-style commode seats)
	“pollen sore”, and
	“tar sore”(tar was formerly commonly used in China to waterproof furniture.)

Causes

The lungs and spleen have a powerful influence in contact dermatitis as they are the main organs that promote and support skin function. In TCM, skin and hair are the barriers ofÂ exogenous evilsÂ invasion, theÂ protective qiÂ that enhances its integrity is regulated by theÂ lungs. Therefore skin diseases are always viewed as indicating a lung disharmony. TheÂ spleenÂ is responsible for extracting nutrients from food and for transporting fluids throughout the body, and impaired function can contribute to unhealthy skin and swelling. In TCM, it is considered that contact dermatitis can be caused by both endogenous (originating from inside the body) and exogenous (originating from outside the body) factors.

Inborn susceptibility (endogenous causes)Â
The incidence of contact dermatitis is influenced by body constitution and is more likely to occur in individuals with a congenital/inherited predisposition to the disorder. In cases of congenital deficiency, the skin and tissues beneath are loosely bonded. This means that the protective qi is weak and that the body is more prone to a flare-up of fire evil or to the development of Â internal wind evilÂ . Contact with certain substances, such as lacquer, drugs, plastic, rubber products, dyes or plants, facilitates transformation of Â heat evilÂ internally in the body. The conflict between blood and qi against the heat evil triggers the skin disease.

Environmental pathogen invasion (exogenous causes)
In situations where external pathogens are allowed to invade the body directly, excessive fire evil will develop and accumulate. Circulation of blood and qi in the surface areas of the body becomes disturbed and does not flow smoothly. This in turn damages the integrity and function of the skin causing dermatitis.Â

Symptoms

The main symptoms of contact dermatitis are the appearance of a rash accompanied by an itchy, burning sensation and swelling. The rash may develop into clusters of red papules (raised spots) or, in severe cases, blisters. Scratching of the rash causes exudation (leakage) and an exacerbation of the irritation. On rare occasions, swelling and tenderness of the eyelids, lips andÂ perineumÂ can occur.

Contact dermatitis usually results in excessive stimulation of body functions. It is described in TCM as an asthenia syndrome and results from a relatively strong body-resistance in fighting excessiveÂ pathogensÂ . The usual presentation in an asthenia syndrome is fever, thirst, irritability, abdominal discomfort, constipation and dark-colored urine. Severity varies with the progression of the disease.

TCM practitioners will examine the sufferer and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during the different stages of the disease. Contact dermatitis can be classified into the following types:

Excessive fire accumulation
This form of contact dermatitis presents with acute onset. The skin at first appears pink, or with a red rash, and there is a distinct margin and edematous accumulation of fluid in the tissues base. The rash then develops into clusters of papules (raised spots) and is accompanied by a burning sensation and itchiness. Associated systemic symptoms include mouth dryness, thirst, fever, irritability, dark urine and constipation.

Excessive fire mixed with dampnessÂ
This is a more serious form of the condition. The red papules are edematous and blisters develop which may be as large as an egg-yolk. If the rash is scratched, fluid will leak out. The rash can be extremely itchy and the lesion may become swollen and create a sensation of burning. Systemic upset includes mouth dryness and poor appetite.

Blood deficiency accompanied by wind and dryness accumulationÂ
With repeated relapses of the disorder, the skin lesions become thickened, dry and scaly. The lesion may also develop lichen-like changes (skin develops a thickened leathery appearance). The severity of the irritation results in scars on the skin from excessive scratching.

Diagnosis

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:Â

	QuestioningÂ The TCM practitioner will establish the medical history of both the patient and his family.
	ObservationÂ Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
	Listening and smellingÂ The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
	TouchingÂ Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

Contact dermatitis is commonly diagnosed by the following disharmony patterns:Â

Excessive heat accumulation
From the TCM viewpoint, all allergenic substances are regarded as evils orÂ pathogensÂ . Hypersensitive reactions of the body are the result of accumulation of evils, impaired functioning ofÂ organsÂ or disruption to the circulation of Â bloodÂ andÂ qi. The pathogens induce internal changes and encourage the accumulation of excessiveÂ heat evilÂ . This disturbs the movement of qi and blood in the skin and gives rise to a burning itchy rash. On examination the tongue is red and covered by a thin layer of yellow fur. The pulse is taut and slippery.

Excessive fire mixed with dampnessÂ
The lungs have an important role as regulator of theÂ protective qiÂ . The spleen provides nutrients for the skin. If theÂ lungsÂ andÂ spleenÂ are functioning poorly,Â external pathogensÂ can readily invade the body and fire andÂ dampness evilsaccumulate. The evils stagnate on the skin meridians causing the appearance of a bullous or blistered rash with edema and leakage of fluid. On examination, the tongue is red and covered with a yellow greasy fur. The pulse is slippery and rapid.

Blood deficiency and wind and dryness accumulation
If the spleen is not functioning properly, there is a decline in acquiredÂ jing (essence)Â and nutrients in the body and this affects the production of blood. This reduction in blood supply causes the skin to lose nutrients. It becomes prone to the development of wind evil and this can turn intoÂ dryness evil. The skin appears dry, scaly and thickened. On examination, the tongue is pink and covered with a thin fur. The pulse is taut, thready and rapid.

Differential diagnosis
Contact dermatitis can be differentiated from other skin disorders such as acute eczema and facial erysipelas (an acute bacterial infection of skin) by the following features:

	In acute eczema, the skin lesion may appear in several forms, there is symmetrical distribution in certain locations and the margins of the rash are usually hard to identify. The condition is of longer duration and can become chronic. There is no obvious contact history with particular substance that could be responsible for the skin condition.
	Facial erysipelas presents with severe systemic symptoms such as chills, high fever, headache and nausea. The rash appears as a red patch of inflamed skin with underlying swelling. The edge of the patch is palpably raised and clearly defined. There is a burning sensation in the lesion and it is tender but not itchy. There is not contact history.

Treatment

Internal Therapy

Traditional Chinese medicine aims at a holistic approach. Skin diseases are associated with internal disharmony betweenÂ yin and yangÂ and are the superficial presentations of internal damage.

1.	Excessive heat accumulation

Therapeutic aim:To eliminateÂ heatÂ and toxic materials, cool theÂ bloodÂ and clear the rash.

Prescription 1:Â Puji xiaodu dissolution drink (reduces rashes of the face and head).

ban lan gen	isatis root
lian qiao	large head atractylodes root
huang qin	baical skullcap root
huang lian	golden thread
yuan shen	figwort root
ma bo	puff-ball
niu bang zi	great burdock achene
bo he	peppermint
jiang can	stiff silkworm
chen pi	dried tangerine peel
jie geng	platycodon root
chai hu	Chinese tororwax root
sheng ma	cimicifuga rhizome
gan cao	liquorice root

Prescription 2:Â Liangxie jiedu decoction (for rashes on other parts of the body).

shang di	dried rehmannia root
chia hao	red peony root
jin yin hua	honeysuckle flower
lian qiao	weeping forsythia capsule
ban lan gen	isatis root
pu gong ying	dandelion
ye ju hau	wild chrysanthemum flower
dan pi	tree peony bark
zi cao	gromwell root
huang qin	baical skullcap root

2.	Excessive heat mixed with dampness

Therapeutic aim:Â To disperse heat andÂ dampness evilsÂ and to eliminate toxins and swelling.

Prescription:Â Longdan xiegan decoction.

chai hu	Chinese tororwax root
huang qin	baical skullcap root
long dab cao	Chinese gentian
zhi zi	Cape jasmine fruit
che qian zi	plantain seed
shang di	dried rehmannia root
dang gui	Chinese angelica
ze xie	oriental water plantain root
gan cao	liquorice root

3.	Blood deficiency and wind anddrynessÂ accumulation

Therapeutic aim:Â To disperse heat andÂ wind evils, nourish the blood and re-hydrate the skin.Â

Prescription 1:Â Xiaofeng powder.

dang gui	Chinese angelica
sheng di	dried rehmannia root
fang feng	divaricate saposhnikovia root
chan tui	cicada slough
zhi mu	common anemarrhena root
ku shen	light yellow sophora root
hu ma	common flax
jing jie	fine-leaf schizonepeta herb
cang zhu	atractylodes root
niu bang zi	great burdock achene
shi gao	gypsum
gan cao	liquorice root

Prescription 2:Â Danggui decoction

sheng di	common yam root
chuan xiong	Szechwan lovage root
jing jie	fine-leaf schizonepeta herb
fang feng	divaricate saposhnikovia root
bai ji li	puncture vine caltrop fruit
dang gui	Chinese angelica
he shou wu	fleece flower root
bai shao	white peony root
huang qi	milk vetch
gan cao	liquorice root

External therapy

Of greatest importance in the treatment of contact dermatitis is the identification of the causative agent and its subsequent avoidance. Therapeutic approaches in skin lesions are also important. In order to facilitate healing, any substance used should be mild, non-stimulating and simple to apply. The following are examples:

	For simple rashes: Sanhuang lotion or indigo powder lotion.
	In cases of severe exudation and erosion of skin lesions: Moist dressings should be applied soaked with the following decoction:

Â	lu cha	green tea
Â	ma chi xian	purslane herb
Â	huang bai	amur cork-tree
Â	yang di cao	emilia sonchi folia
Â	shi wei	pyrrosia leaf
Â	pu gong ying	dandelion
Â	sang yu	mulberry leaf

Where erosion and scarring have occurred on the skin lesion: Indigo emulsion.

In cases of scaling, thickening, coarse or lichen skin: Black soybean-distillate ointment.

Examples follow of some folk prescriptions which can be applied to skin lesions:

1.	Fresh ground purslane herb.
2.	If vesicles appear on the rash, the following decoction can be used as a wash or soak:

Â	huang qin	baical skullcap root
Â	huang bai	amur cork-tree
Â	ma chi xian	purslane herb
Â	ming fan	alum

3.	Where the lesion has been scratched and there is exudate, washing or soaking with this decoction is useful:

Â	shang di yu	fresh garden burnet root
Â	huang bai	amur cork-tree

4.	Fresh ground mung beans.
5.	Fresh balsam pear.

Acupuncture and moxabustion
As contact dermatitis is seen as anÂ asthenic (excessive) syndrome, acupuncture given using reduction or purgative therapeutic methods at two to four points can be helpful. Acupuncture points: chi-ze, qu-chi, he-gu, qu-ze, zu-san-li, wei-zhong, san-yin-jiao.

Dietary therapy
A congee made from mung bean and coix (raw Job’s tears) seed can also be beneficial.

Prevention

Prevention of contact dermatitis depends on the following:

	Investigation of the medical history to identify irritants for future avoidance.
	If the irritant is occupation-related, working procedures should be modified or the environment improved to avoid the irritant. Precautionary measures should be re-enforced such as the wearing of protective clothing and gloves to cover the skin if working with an irritating substance.
	Hot baths should be avoided when a rash is present as this may make the condition worse. Lesions should not be scratched. If Western drugs are needed, they should be applied only under medical advice.
Â	Â

Dietary measures
From the TCM viewpoint, both food and drugs come from the same source and food can vary in character. This means that food can promote health or have an adverse effect on it. Seafood, spicy and hot food trigger the body to produce more wind, heat or dampness evils, which are causative factors in contact dermatitis. In TCM, dietetic restraint is urged, meaning that some foods should be avoided in certain disorders or while certain medicines are being taken. For example, intake of salty food should be limited in persons who are edematous have fluid retention and a greasy diet avoided in cases of diarrhea. For contact dermatitis, a balanced diet should be eaten. Individuals susceptible to this disorder should avoid alcohol, and eat less seafood or spicy and hot food. Drinking plenty of water is also advisable to clean the toxins from the body and prevent illness.Â

Atherosclerosis

acuherb — Thu, 29 Dec 2011 18:06:58 +0000

Atherosclerosis

AtherosclerosisÂ of the heart, better known as coronary heart disease, is classified in Traditional Chinese Medicine (TCM) as chest pain syndrome. It is characterized by pain in the chest, which may progress towards the back. Patients can also have shortness of breath, especially when lying flat. Symptoms of heart atherosclerosis have been mentioned in ancient medical texts as far back as the Han Dynasty (206BC-220AD). The famous medical work,Â Huang Di Nei JingÂ included a detailed description of this disease, saying, “Patients with chest pain syndrome may have pain inside the chest, fullness and distention in the lower chest, pain in the back of the shoulder as well as pain in the upper arm.” Another example of early writing on this subject is the description in theÂ Synopsis of the Golden ChamberÂ written by the famous Chinese medical doctor Zhang Zhong Jing who was also from theÂ Han Dynasty. He wrote, “Chest pain syndrome usually presents as wheezing and cough, pain in the back of the shoulder and shortness of breath. The pulse at the first position will be slow and sinking while the pulse at the second position will appear rapid with slight tightness. In this case, Gualou Shebai Decoction ( Melon pedicel and Longstamen onion bulb ) should be used.” Since then, other works dealing with the symptoms, diagnosis and different treatments for atherosclerosis have been written at different times.

Causes

According to TCM theory, chest pain syndrome has the following causes:

1. Weakened health due to aging
According to TCM theory, elderly people gradually suffer a decline inÂ kidneyÂ qi, resulting in different health problems. Declining kidney functions may be manifested as kidneyÂ yinÂ deficiency and/or kidneyÂ yangÂ deficiency. A deficiency in kidney yang can lead to yang deficiencies of the five yin organs (liver,Â heart,Â spleen,Â lungsÂ , andÂ kidneys), which means that the functional aspects of these organs will have insufficient support. As a result, heart yang becomes deficient and fails to perform normal functions. On the other hand, if kidney yin becomes deficient, there will be insufficient yin nourishment of the five yin organs leading to heart yin deficiency. (In western terms, heart yang may actually be understood as the pumping action of the heart and is related to the sympathetic nervous system’s excitatory influence on the circulatoryÂ system. Heart yin, on the other hand, may be understood as metabolic nourishment of the heart. It is related to the parasympathetic nervous system’s inhibitory influences.) Deficiency of both heart yin and yang will ultimately lead to poor circulation ofÂ qiÂ andÂ bloodÂ Â in the body, since the heart is responsible for “ruling” the blood. Consequently, qi will become too stagnant to “push” the blood around the body, and blood stasis (a condition where the blood
Â is unable to flow smoothly) will occur. Blockage of the blood vessels in the heart andÂ meridiansÂ Â can then lead to chest pain. In western terms, this is known as angina.

2. Improper dietÂ
If our diet contains too much fatty and greasy food, digestion will be harmed. In TCM, it is said to affect theÂ spleenÂ harmony. As a result, the spleen cannot transform food and liquids into a nutritive essence used for qi and blood formation and then transport this essence throughout the body. The untransformed fluids and food start to accumulate and gradually form into an unhealthy dampness called “phlegm.” Phlegm dampness is one of the pernicious evils that has viscous (sticky) and stagnant properties. Therefore, it blocks the vessels and inhibits the flow of qi and blood, which in turn leads to chest pain.
The relationship between a person’s diet and chest pain in TCM is very important. This thinking is similar to the western medical view that eating too much cholesterol and fat is a factor in the development of atherosclerosis.Â

3. Emotional disorderÂ
As already discussed, unhealthy phlegm dampness will lead to stagnation of qi and blood, which is considered a main cause of chest pain. Sometimes, emotional disorders lead to the formation of phlegm dampness. For example, “thinking too much”, (earth elementÂ of the five emotions), will harm the spleen (earth element of the five organs). Without healthy transformation of the spleen dampness will accumulate. Anger (wood elementÂ of the five emotions) also affects the liver (wood element of the five organs). As a result, theÂ liverÂ can lose its spreading
properties and fail to maintain the smooth flow of qi. The constrained liver qi will finally form into liver fire. It burns the body fluids and turns them into viscous (sticky) and unhealthy phlegm, which leads to chest pain.

4. Attack of coldness evilsÂ
In TCM, “coldness” is associated with increased viscosity (stickiness) and stagnant properties. An example of this is oil which becomes viscous and does not pour easily when it is cold. As coldness belongs to yin, its influence will inhibit heartÂ
yang. Without sufficient heart yang, the heart cannot “rule” the blood properly. Therefore, heart vessels and meridians become blocked, and chest pain results.Â

Symptoms

In TCM, the symptoms of chest pain syndrome depend on the disharmony patterns.

1. Blockage of heart vessels due to a blood stasis patternÂ
WhenÂ qiÂ becomes stagnant and blood stasis occurs, the patient feels sharp pain in the chest that stays in one spot because the blood is unable to circulate. (It should be noted that since blood stasis belongs to excessive evils, the pain is sharp. If the problem is due to deficiency, the pain is dull.) . Being classified as a yin evil, blood stasis will cause problems in yin environments, especially nighttime. Therefore, people with this problem usually feel more pain at night. On examination, the tongue appears dull and purple, and the pulse feels choppy and sinking, both of which are signs of blood stasis.

2. Blockage due to a phlegm dampness patternÂ
An accumulation of unhealthy phlegm dampness constrains the heart yang, making the patient feel an obstructing pain in the chest. As the nearbyÂ heart meridianÂ is blocked by the dampness, the pain progresses to the back of the shoulder. Since phlegm dampness is related to disharmony of the spleen, and the spleen rules the four limbs, individuals with this pattern may feel tired and have a heavy feeling in their limbs. They will also have a cough and shortness of breath. On examination, the tongue coating looks greasy and turbid, and the pulse feels smooth.

3. Deficiency of both qi and yinÂ
Qi is essential for pushing or circulating blood throughout the body. Yin properties are closely associated with blood. If qi and yin are deficient, blood flow will be slowed, leading to blood stasis. As a result, these patients experience paroxysmal (sharp, spasmodic) pain, which occurs from time to time. Insufficient yin nourishment of the heart causes it to beat faster and palpitations to occur. TheÂ yin deficiencyÂ can also result in a relative excess of yang or illusionary yang, which is not a trueÂ yang excessÂ because it is caused initially by yin deficiency symptoms. The relative yang excess rises to the head, leading to dizziness and blurred vision. Patients may look pale and fatigued and have difficulty speaking. Shortness of breath due to qi deficiency can also be present. On examination, the tongue appears red with teeth marks, and the pulse feels weak.

4. Deficiency of heart yangÂ
Deficiency of heart yang causes disharmony of qi and blood flow and presents with symptoms of dull chest pain and shortness of breath. If the condition is severe, the pain may even spread to the entire back. Without sufficient heart yang, palpitations and spontaneous sweating will occur since sweat is thought to be the “fluid of the heart”. The pain is usually projected to regions along theÂ heart meridianÂ and progresses to the inner side of the upper arm and the armpit. On examination, the tongue looks pale, and the pulse feels frail, sinking and weak.

5. Obstruction of heart yangÂ
Obstruction of heart yang is usually triggered by an attack of cold evils. As a result of the cold attack, the yang qi movement cannot flow smoothly and becomes obstructed, causing pain in the chest. In severe cases, the pain radiates to the whole back and progresses along theÂ heart meridian, affecting the inner side of the upper arm and armpit. After each episode, spontaneous sweating usually occurs. On examination, the tongue has a white coating, and the pulse is sinking and weak. Sometimes it may feel slow.

6. Deficiency of kidney yangÂ
A person withÂ kidneyÂ yang deficiency will have cold limbs, an aversion to cold and suffer from loin (waist) pain A kidney deficiency often causes fatigue and frequent urination. As discussed before in the ‘Causes’ section, a kidney yang deficiency can lead to a deficiency of heart yang, which in turn, results in chest pain.

Diagnosis

1.	Blockage of heart vessels due to ae blood stasis pattern.
2.	Blockage due to a phlegm dampness pattern
3.	Deficiency of both qi and yin
4.	Deficiency of heart yang
5.	Obstruction of heart yang
6.	Deficiency of kidney yang

Detailed descriptions of these have been given in the “symptoms” section.

According to TCM theory, individual with chest pain syndrome should be differentiated from either a fluid retention syndrome in the throat, stomach pain or emergency heart pain.

Fluid Retention Syndrome in the Thorax (Chest):
‘Fluid retention syndrome in the thorax’ is an accumulation of fluid dampness in the thorax. Its presentation is similar to chest pain syndrome. Both lead to chest pain, but fluid retention syndrome is usually associated with persistent distension of the lower chest region, which will be aggravated by coughing, spitting and breathing. Shortness of breath might also be present.

Stomach Pain:
Some forms of chest pain originate from the stomach area and can easily be confused with chest pain syndrome. However, stomach pain is usually associated with hiccupping, flatulence (gas) and regurgitation of stomach acid.

Emergency Heart Pain:
Emergency heart pain is a complication of chest pain syndrome. It is marked by persistent, severe heart pain. Patients look pale, have purple lips, cold limbs and sweat. The pulse is frail and weak. This is an emergency and must be treated immediately by trained medical staff, preferably in a hospital emergency room.

Treatment

TCM treatments are syndrome basis, below are the usual clinical syndromes associated with atherosclerosis:

1. Obstruction of heart-blood

Therapeutic aims:Â activating the blood and removing the obstructions.

Sample of Prescription:Â (1) Dan Shen Drink (ä¸¹åƒé£²)

dah shen	Red sage root
tan xiang	Sandalwood
sha ren	Fruit of Villous Amomum

In the prescription, red sage root specializes in activating the blood and removing the blood stasis, moreover, it can ease the pain that induced by the stasis. The sandalwood warms the middle burner and helps to regulate the qi circulation in the region. Villous Amomum fortifies the transforming and transporting functions, which help to dispel the qi stagnation in the middle burner. The three herbs interact and promote each other to resume the balance of the heart.

Sample of Prescription:Â (2) Decoction of Driving out Stasis in the Mansion of Blood (è¡€åºœé€ç˜€æ¹¯)

dang gui	Chinese angelica root
chi shao	Red peony root
chuan xiong	Szechuan lovage
tao ren	Peach kernel
hong hua	Safflower flower
chai hu	Hareâ€s ear root
zhi qiao	Orange fruit

In the prescription, angelica, lovage, kernel and safflower flower specialized in activating the blood and removing stasis; hareâ€s ear regulates the liver functions, orange fruit enhances the qi circulation. The qi dominates the blood movement, as a result, the bodyâ€s blood circulation can be improved and cardiac pain is eased.

2. Obstruction of turbid phlegmÂ
Therapeutic aim:Â dispelling the turbid phlegm.

Sample of prescription:Â Decoction of Melon pedicel, Longstamen onion bulb and Pinella tuber (ç“œè”žè–¤ç½åŠå¤æ¹¯åŠ æ¸›).

Prevention

TCM always stresses balance and harmony. Paying attention to the following points will help individuals maintain good cardiovascular health.

1. Healthy diet
According to TCM theory, the diet is closely related to spleen health, which in turn is essential for the transformation of food into qi and blood in the body. The accumulation of dampness from improper spleen function is the main cause of chest pain syndrome. Hence, it is extremely important to maintain a healthy diet and avoid fatty, greasy foods.

2. ExerciseÂ
Appropriate exercise helps promote qi and blood flow in the body. Their smooth circulation is essential to maintain cardiovascular health. However, individuals need to avoid over-exercising, as this can exhaust too much qi in our bodies. This is especially important for people who are deficient in qi or yang because over-exercising can trigger chest pain syndrome. It is a good idea to get the advice of your healthcare provider before starting an exercise regimen.Â

3. Emotional healthÂ
Proper relaxation and rest are also important for good cardiovascular health. Lack of relaxation and rest can lead to emotional disorders. In TCM, this is said to harm the health of the liver or spleen. The liver maintains the smooth flow of qi while the spleen is essential for transforming fluid and food. If disharmony occurs in these organs, the circulation of qi and blood will be affected which, in turn, causes blood stasis and finally leads to chest pain.Â

Acute Leukemia

acuherb — Mon, 26 Dec 2011 22:28:07 +0000

Â Acute Leukemia

Acute leukemia is a malignant proliferative disease that originates from blood producing tissues in the body. It is characterized by symptoms that include anemia, bleeding, fever and infiltration symptoms such as enlargement of the spleen liver and lymph nodes.

Acute leukemia, also referred to by its common subtypes of acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML), is a modern medical term that cannot be found in the ancient Chinese medical classics. However, its symptoms are similar to some TCM diseases. Acute leukemia symptoms fall under Traditional Chinese Medicine (TCM) disease categories of “pulmonary tuberculosis”, “hectic fever due to yin-deficiency”, “acute febrile diseases due to insidiousÂ pathogensÂ “, “blood disorders”, “saber”, “subcutaneous nodules” and ” abdominal masses”.

	Pulmonary Tuberculosis:Â This disease causes the same kind of fever and anemia symptoms as in acute leukemia, and is mentioned in the famous medical classic “Sheng Ji Zong Lu” written in 1118 A.D. The title means a collection of medical records.
	Hectic fever due to Yin-deficiency:Â This is a low-grade fever similar to those experienced in leukemia. It results from a yin deficiency and is mentioned in the medical classicÂ “Treatise on the Causes and Symptoms of Diseases” written in 610 A.D.
	Acute febrile diseases due to insidious pathogens: These diseases cause similar high fever symptoms as in acute leukemia associated infections.
	Blood disorders:Â These conditions produce the same bleeding symptoms such as nose bleeds, gum bleeding and blood in the stool.
	Saber:Â Named after its shape, this is the inflammation of the axillary (armpit) and neck lymph nodes caused by tuberculosis bacteria.
	Subcutaneous nodules or abdominal masses:Â This TCM condition presents as infiltration symptoms such as enlargement of the lymph nodes, liver and spleen.

Causes

The major cause of leukemia is aÂ qiÂ deficiency andÂ pathogenÂ invasion that disturbs the harmony and balance ofÂ the body. The ways in which these conditions lead to leukemia symptoms are described below:

1.	When the vital qi (vital energy) is deficient,Â pathogensÂ can more easily invade the body and affect the normal functions of theÂ heart,liver, nutrient qi and blood. When this happens, TCM febrile disease symptoms such as high fever, bleeding, coma and convulsion can occur.
2.	If the body’s internal organs, especially theÂ spleenÂ andÂ kidney,yin and yang, qi and blood, become exhausted after a long period of months or years, the production of qi, blood, essence and bone marrow decline. This leads to leukemia related symptoms such as anemia and fatigue.
3.	A vital qi deficiency and pathogen invasion also affect qi and blood movement and the distribution of body fluid inside the body. Abnormal disturbances of these substances can cause blood and body fluids to leak out from theÂ TaiyinÂ (lung and spleen),Â ShaoyinÂ (heart and kidney) andÂ JueyinÂ (pericardium and liver) meridians, or the disturbance can cause them to accumulate and mix together. When this happens, they transform into a mass or nodule inside the body leading to infiltration symptoms such as liver, spleen or lymph node enlargement.

Symptoms

TCM practitioners will examine the individual, and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during the different stages of the disease. Acute leukemia can be classified into following types:

I. Acute Attack Stage:Â This first phase of the disease is when abnormal white blood cells crowd the bone marrow and blood so that normal blood cells such as red blood cells, normal white blood cells, and platelets cannot be made in their normal amounts. There are four disharmony patterns under this stage.Â

1.	Damp and Heat Type
Â	Individuals have symptoms like a fever that cannot be relieved after sweating, and do not experience an aversion to cold temperatures. Dizziness, fatigue, a full feeling in the stomach and abdominal areas, and diarrhea are common. The urine appears dark yellow and comes in scanty amounts. In serious conditions, individuals will additionally suffer from severe joint pain.
2.	Noxious Heat Type
Â	Individuals suffer from a high fever, heavy sweating, and a pounding, throbbing pain in the head. Abnormal blood circulation symptoms such as bleeding from the nose, gums, or blood in the stool or urine can be present. The skin may also have a bruised appearance or haveÂ petechiae. The blood coagulation problems may cause life threatening symptoms in severe cases such as unconsciousness and bleeding into the brain.
3.	*Accumulated Mass Type*
Â	Masses or nodules appear beneath the skin of both sides of the neck, axilla (armpits) and inguinal regions (groin area). Individuals may experience severe and persistent bone pain, accompanied with restlessness and fever.
4.	*Interior Liver-Wind Stir- Up Type*
Â	Symptoms include severe pounding, throbbing pain in the head, impulsive vomiting, and a stiff neck. These can progress to more serious symptoms such as convulsions, spasms, and even paralysis of the face. In the most severe cases individuals experience an irregular and intermittent pulse, which leads to coma and finally death. The most severe cases occur when the leukemic cells enter the brain and impair its functioning.

II Remission Stage:Â The remission stage is when individuals are recovering from leukemia or are cured from it. This phase begins when the symptoms and signs of leukemia disappear, and the number of white blood cells and other blood cells in the blood or bone marrow return to normal. There are two disharmony patterns grouped under this stage.Â

1.	Deficiency of Qi and Yin Type
Â	Individuals have symptoms like heart palpitations, and shortness of breath. The complexion appears wan and sallow, and the body’s skin itself appears withered and pale. Additional symptoms that may be present include fatigue, poor appetite, chapped lips, dryness of the mouth and throat, restlessness, fever, spontaneous sweating or night sweats.
2.	Deficiency of Qi and Blood Type
Â	Individuals have pale lips, nails and a pale complexion. The skin may appear bruised in certain areas and the mucous membranes inside of the mouth can haveÂ petechiae. Dizziness, vertigo, distension and fullness in the abdomen, poor appetite, and heart palpitations that worsen with activity may also be present.

Diagnosis

Determining the circumstances and manifestations of a disease through inquiry, and by observing the individual’s symptoms are important in TCM. Diagnosis is based on the followingÂ four examination techniques.Â

Through these four techniques a variety of symptoms and signs will be used to identify the individual’s disharmony pattern. This is crucial because at the various stages of a disease, a variety of disharmony patterns are present which require different types of therapy. This is why individuals with the same disease are often treated very differently by their TCM practitioner.Â

A TCM practitioner will not diagnose an individual with acute leukemia. Instead, he or she will diagnose the individual with a disharmony pattern. Particular attention is paid to the following points for differentiation of the various disharmony patterns.

1.	Distinguishing the locations of the illness to find out which organs or systems are involved.
2.	Distinguishing the nature of illness to decide whether the syndrome is yin, yang, excess or deficiency type.
3.	Distinguishing the stage of illness to classify the disease in its acute or remission stages.

Acute leukemia commonly has the disharmony patterns described below:
I Acute Stage of Acute LeukemiaÂ

1.	Damp and Heat Type
Â	This often occurs in the early stage of leukemia, and is mainly caused by a mild deficiency ofÂ qi, and extreme excess of pathogenic heat. Dampness is produced when theÂ stomachÂ andÂ spleenÂ cannot function properly to transform and transport nutrients. As the dampness accumulates over time, it turns into a heat evil which can inflict damage to the body. Upon examination, the tongue is red and covered with yellow, greasy fur. The pulse is rapid.
2.	Noxious Heat Type
Â	This usually occurs at the time when normal blood cell production of white blood cells, red blood cells andÂ plateletsÂ is exhausted due to the overproduction of leukemic cells in the bone marrow and blood. At this stage, noxious heat is extremely excessive, and the remaining vital qi is sparse. Noxious heat and other toxic waste products are produced when the organs hyperfunction and an increase in metabolism is created that results in material consumption of substances such as nutrients and body fluids. As a result, the noxious heat damages theÂ meridiansÂ and blood and causes bleedingÂ symptoms. Upon examination, the tongue is red and dry and covered with yellow, dry fur. The pulse feels rolling and rapid.
3.	Accumulated Mass Type
Â	Noxious heat and phlegm evils transform into masses when they stagnate, and block theÂ collateralsÂ (part of the meridian system) in the course of leukemia. Upon examination, the lips and tongue appear pale, and the tip and the margin of the tongue exhibitsÂ petechiae. The pulse feels deep and fluttery.
4.	Interior Liver-Wind Stir-Up Type
Â	This usually occurs at the terminal stage of acute leukemia, and develops from the stirring up of interior wind evils. In this stage, the body accumulates excessive noxious heat, which consumes body fluids and damages the blood and meridians. This triggers endogenous pathogenic wind that seriously disturbs the movement of qi and blood. Wind evils affect theÂ liver, which is responsible for helping with the flow of qi and blood. The wind evils are the result ofÂ yin deficiency, hyperactivity of liver-yang or excess heat evils. This type can also be caused by phlegm evils blocking the clear orifices such as the mouth. Upon examination, the tongue appears red and dry is coated with little or no fur. The pulse is stringy and rapid.

II Remission Stage of Acute LeukemiaÂ

1.	Deficiency if Qi and Yin Type
Â	This occurs in a late stage of leukemia when the body is trying to recover from the damage the disease has inflicted. Qi and yin have been exhausted for a long period and the heart, spleen and body fluid distribution are no longer functioning normally. Upon examination, the tongue appears red and is covered with scanty or scaled fur. The pulse feels deep, thready and rapid.
2.	Deficiency of Qi and Blood Type
Â	This also occurs at the late stage of leukemia where the body is starting to recover. During this stage, vital qi begins to convalesce, and the heat, wind or damp evils start to disperse. The body is getting better from the illness, but the impaired organs, qi and blood are still very weak. Upon examination, the tongue is pale and swollen with indented margins, and covered with a thin, white fur. The pulse sign is deficient and heavy or soft and thready.

III Differentiating acute leukemia from other illnesses

In the clinical diagnosis of TCM, acute leukemia should be differentiated from other similar diseases.Â

1.	Consumptive Disease
Â	This is a disease caused by insufficiency of vital qi and blood, or organ deficiency. When the individual experiences fever and anemia, it should be distinguished fromÂ aplastic anemia, which comes under the category of consumptive disease. In the whole course of this type of disease, there are no nodules or abdominal mass, so it is easy to differentiate.
2.	Blood Disorders
Â	Blood disorders involve spontaneous bleeding diseases such as thrombocytopenia (not enoughÂ plateletsÂ to clot the blood), abnormal blood vessels and blood coagulation factor deficiencies. These specific blood disorders can be detected in leukemia patients through blood tests.
3.	Fever Caused by Exogenous (external) evils
Â	This type of fever is usually induced byÂ seasonalÂ pathogens. It usually presents with persistent high fever and excessive interior heat. Interior heat is produced when there is a pathological disturbance in the physiological functions of the qi, blood, body fluids and organs. With this type of fever, the individual’s blood parameters are normal, and it is easy to recover from the fever. However, leukemia sufferers usually have a persistent low-grade fever, but when it is complicated by infections, the temperature will be high.

Treatment

In TCM, the treatment of acute leukemia is based on the type of disharmony pattern.

ACUTE Â STAGE:

1. Damp and Heat Type:

Therapeutic aim:Â Due to an accumulation of damp-heat and toxic pathogens in the whole body, treatment focuses on clearing away heat and dampness evils, eliminatingÂ pathogens, and removing toxic substances.

Example of Prescription:Â Chaiqin Chenling decoction with modificationÂ

chai hu	chinese torowax root
huang qin	baical skullcap root
long dab cao	chinese gentian
zhi zi	cape jasmine fruit
chen pi	dried tangerine peel
fu ling	Indian bread
ban xia	pinellia tuber
ze xie	oriental water plantain rooti
zhu ling	chuling
bai zhi	large head atractylodes rhizome
lu gen	reed rhizome
she she cao	herba hedyotis diffusa
qing dai	natural indigo

2. Noxious Heat type

Therapeutic aim:Â This is caused by excessive noxious heat in the interior, and the disturbance of nutrientÂ qiÂ andÂ blood. Treatment includes clearing away heat evils, removing toxic substances, and clamping down on blood circulation to stop bleeding.Â
Example of Prescription: Shuiniujiao Dihuang decoction with modificationÂ

shui niu jiao	buffalo horn
sheng di	dried rehmannia root
dan pi	tree peony bark
chis hao	red peony root
yin hua	honeysuckle flower
lian qiao	weeping forsythia capsule
zhi zi	cape jasmine fruit
sheng shi gao	gypsum
bai hua she she cao	herba hedyotis diffusae

For delirium caused by intensive heat, Zixue pill, Zhibao pill or Angong Niuhuang pellet is helpful.Â

3. Accumulated Mass type

Therapeutic aim:Â This is caused by stagnant phlegm lingering in the interior and blocking theÂ collaterals (meridians). Therefore, treatment includes promoting blood circulation, removing obstruction in meridians, and softening and resolving hard masses.Â

Example of Prescription:Â Taohong Siwu decoction with modificationÂ

tao ren	peach kernel
hong hua	safflower
chuan xiong	szechwan lovage root
dang gui	chinese angelica
di huang	rehmannia root
chis hao	red peony root
hai zao	seaweed
bie jia	turtle shell
sheng mu li	fresh oyster shell
zhe bei	thunberg fritillary bulb
xia ku cao	spike of prunella

4. Internal Liver-Wind Stir Up Type

Therapeutic aim:Â Individuals with this type are in the most critical condition. Emergency treatment includes using aromatic drugs for resuscitation, and suppressing the hyperactiveÂ liverÂ to relieve theÂ wind syndrome.Â

Example of Prescription:Â Zhengan Xifeng decoction

huai niu xi	achyranthes root
sheng long ku	unprocessed fossil fragment
sheng bai shao	white peony root
tian dong	asparagus root
sheng mai ya	fresh germinated barley
dai zhe shi	ochre
sheng mu li	fresh oyster shell
xuan shen	figwort root
chuan lian zi	szechwan chinaberry fruit
yin chen hao	virgate wormwood herb
gui ban	tortoise shell
gan cao	liquorice root

Additionally, Zixue pill and Angong Niuhuang pellet can be taken with water.

REMISSION STAGE:

1. Deficiency of Qi and Yin Type

Therapeutic aim:Â The toxins and heat evils impair heart-qi, and burnÂ primordial yin. As a result, treatment benefits the qi, nourishes the heart, aids theÂ yinÂ and invigorates theÂ kidney.Â

Example of Prescription:Â Shenmai, Erzhi plus Dihuang decoction with modification

bei sha shen	coastal glehnia root
mai dong	dwarf lilyturf tuber
wu wi zi	chinese magnoliavine fruit
nu zhen zi	glossy privet fruit
han lian cao	ecliptai
gou qi chi	barbary wolfberry fruit
sheng di	dried rehmannia root
dan pi	tree peony bark
fu ling	indian bread
yi yi ren	coix seed
bai ji li	puncturevine caltrop fruit
gui ban	tortoise shell

For individuals with residual toxic substances:Â

she she cao	herba hedyotis diffusae
ban zhi lian	chinese lobelia herb

2. Deficiency of Qi and Blood Type

Therapeutic aim:Â This type is caused by the deficiency of both qi and blood. In TCM, the Â spleenÂ Â is responsible for the production of blood and qi. TheÂ kidneyÂ is responsible for storing the essence, which is the source for blood and qi. Therefore, treatment includes replenishing the qi, nourishing the blood, and invigorating the spleen and kidney.

Example of Prescription:Â Danggui Buxie decoction plus Sijun, Bazhen decoction with modification

huang qi	milkvetch root
dang shen	pilose asiabell root
dang gui	chinese angelica
bai zhi	large head atractylodes rhizome
fu ling	indian bread
shu di	processed rehmannia root
qi zi	barbary wolfberry fruit
nu zhen zi	glossy privet fruit
e jiao	donkey-hide gelatin

For individuals with residual toxic substances and hyperactivity of minute collaterals (meridians):

she she cao	herba hedyotis diffusae
xiao ji	field thistle herb

Prevention

From TCM’s viewpoint, prevention includes two aspects:

1.	Preventing the onset of disease
2.	Preventing the progression of disease

Prevention of Disease Onset:

Stay away from evils such as wind and heat that invade the body and cause disease is important. Eat a proper diet, exercis regularly, maintain peace of mind by having an optimistic outlook on life. Get enough rest, and maintain a balanced lifestyle.

Prevention of Disease Progression:

Individuals who suffer from acute leukemia should maintain an optimistic attitude, and actively participate with doctors in deciding treatment options. Keeping up good personal hygiene, eating a moderate diet, avoiding smoking and alcohol and avoiding overstrain or mental excitement are also important ways to prevent disease progression.
Special attention should be paid to following conditions:Â

	When bleeding symptoms like the appearance of large body bruises, nose bleeding and gum bleeding occur, strict bed rest is recommended.
	Leukemia sufferers are more susceptible to exogenous (external) pathogens, so they should be kept in a warm, clean and ventilated room, which should be sterilized regularly to prevent infection.

Allergic Rhinitis

acuherb — Thu, 22 Dec 2011 22:43:45 +0000

Allergic Rhinitis

Allergic rhinitis or hay fever is a disorder characterized by acute attacks of nasal itching, congestion, watery nasal discharge, and sneezing. The episodes occur frequently with short intervals, or remission periods, between attacks. Attacks commonly occur in the morning and at night. Affected individuals are completely normal between episodes. The disorder is due to a hypersensitivity reaction to certain substances that affect the mucous membranes of the nose and associated glands. The disease presents in both seasonal and perennial forms.

In the traditional Chinese medicine (TCM) classicÂ Huang Di Nei Ning (The Yellow Emperor’s Medicine Classic), a similarly described disease is referred to as “bi-qiu”, or “qiu-ti”. “Bi-qiu” means profuse watery nasal discharge; “qiu-ti” means sneezing and profuse watery nasal discharge.

From the TCM viewpoint, the nose has both respiratory and olfactory (smell) functions. It works closely with theÂ lungs,kidneys,Â spleen, andÂ meridians. The lungs open into the nose and nasal function is mainly dependent on the action of the lung energy, qi. The free movement of the lung qi keeps the nasal passages clear and maintains an accurate sense of smell. The governing meridian (Du Mai), a channel system of the midline controlled by the kidneys, passes through the nose. The kidneys thus communicate with the nose. The spleen is the primary organ of digestion and its main function is to transform food intoÂ essence (jing)Â . This is then transported to the lungs and heart where it is used to createÂ qiÂ andÂ blood. Normal spleen function therefore facilitates proper functioning of the lungs; when the spleen is impaired, phlegm-related disorders may develop.Â

Causes

Qi deficiency (internal factors)
A deficiency inherited at birth, chronic illness, over-exertion, improper diet, or emotional disturbances can damage the organs. Under-functioning of organs and an irregular flow ofÂ bloodÂ andÂ qiÂ make the body susceptible to illness. In allergic rhinitis, the lungs, spleen, and kidneys are the main organs which are involved.

1.	Deficiency ofÂ lungÂ qiÂ The lungs and nose belong to same system: the lungs control the nose and the nose is the surface orifice of the lungs. Improper function of the lungs will affect the nose. The process also impairs theprotective qiÂ and enables theÂ exogenous evilsÂ to invade the nose more easily. The result will be frequent episodes of nasal problems, such as obstruction, watery discharge, and sneezing.
2.	Dysfunction ofÂ stomachÂ andÂ spleenÂ When this occurs a decline in the formation of qi and blood results and the nose will lose its supply of nutrients. This causes a disorder of the nasal mucosa (mucous membranes) and nasal obstruction, watery discharge, and sneezing result. The sense of smell is also affected.
3.	Deficiency ofÂ kidneyÂ qiÂ When the kidneys fail to assist the lungs in using qi sent down to them from the lung and to regulate the fluid balance in the body, the circulation of qi and water become affected. Impairment of kidney function will result in inadequate kidneyÂ essence (jing)Â to maintain the functions of the nose. Symptoms will be seen such as a pale, swollen nasal mucosa, frequent episodes of nasal itching, sneezing, and watery discharge.

Invasion of exogenous evils (external factors)
Located in the center of the face, the nose from a TCM viewpoint is sited in the mostÂ yangÂ part of the body. Exogenous yang evils, such asÂ wind evil, can attack it easily. This invasion is usually accompanied by other evils such as the coldness, heat, orÂ dampness evil. As the nose is the external opening of the lungs and helps the lungs to control the protective qi, whenÂ exogenous evilsÂ attack the qi, nasal disorders commonly occur.Â
Furthermore, when the body constitution is weak, such as when there is a deficiency of lung qi, or the protective qi is not strong enough, exogenous evils can attack the nose simultaneously and nasal disorders result. TCM considers acute or recent attacks of rhinitis or hay fever to be mainly the result of external factors, whereas chronic or frequent relapses are mainly due to internal factors.Â

Symptoms

Chinese practitioners will collect the information they need to make a diagnosis through the process of consultation, assessing systemic symptoms, and then determining the disharmony pattern that fits the individual. The following are the usual types of disharmony patterns for allergic rhinitis:Â

1.	Deficiency ofÂ lungÂ qi, invasion byÂ windÂ and coldness evils
Â	Individuals present with nasal itching, sneezing, congestion, and a watery discharge. Symptoms are usually triggered by being exposed to wind or a cold temperature in the morning. Systemic symptoms include pallor, shortness of breath, ease of sweating on exertion, and aversion to cold.
2.	Lung andÂ spleenÂ deficiency,dampnessÂ accumulation in the nose
Â	Individuals usually present with symptoms such as sneezing with watery discharge and moderately severe nasal obstruction. These can be accompanied by heaviness in the forehead or a pounding pain between the eyebrows. Other symptoms include a loss of sense of smell, fatigue, shortness of breath, aversion to cold, a heavy sensation in the limbs, abdominal fullness, a poor appetite, and diarrhea.
3.	Depletion inÂ kidney yang, lungs lose promoting and warmth support from the kidneys
Â	Individuals suffer from nasal obstruction, sneezing with watery discharge, severe aversion to cold, and coldness in the limbs. The symptoms are usually triggered by a cold temperature. Other symptoms include dizziness, ringing in the ears, frequent nocturnal urination, impotence and premature ejaculation, and a hot sensation in the palms and soles of the feet.
4.	Spleen deficiency, stagnation ofÂ phlegm evil
Â	Individuals present with a more severe nasal obstruction, copious watery discharge, and discomfort from nasal itching. They may also experience heaviness in the head, weakness of the limbs, fullness and discomfort in the chest and gastric regions. They may produce copious white sticky sputum, and have a poor appetite, and diarrhea.
5.	Invasion of wind and heat evils in the lungs
Â	Typical presentations of this type of disharmony pattern include frequent episodes of sneezing, nasal itching, and complete obstruction of the nasal orifices by a heavy discharge. When stimulated by foreign evils or heat evil, a copious watery discharge will develop. Periodic relapse and remission will occur. There will be general symptoms like fever, aversion to cold, headache, and sweating.

Diagnosis

Based on theÂ four examination technique, TCM practitioners make a diagnosis according to clinical symptoms and further characterize the disorder by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have.Â

In allergic rhinitis, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

1.	Deficiency ofÂ lungÂ qi, invasion by wind and coldness evils
Â	Due to a constitutional weakness, the individual is susceptible to influenza or other illnesses. In terms of TCM, this usually means that the individual does not have strongÂ protective qiÂ and this enables theÂ wind evilÂ and coldness evils to invade the nose easily. On examination, the nasal mucosa is pale and swollen, with a slight watery discharge. The tongue is pale and covered by white fur. The pulse is weak and feeble.
2.	Lung andÂ spleenÂ deficiency, dampness accumulation in the nose
Â	When the lungs and spleen are deficient or under-functioning, an imbalance of body-fluid metabolism andÂ dampness evilÂ ccumulation results. Dampness evils flow through the meridians and accumulate in the nose to produce a swollen, pale nasal mucosa and excessive secretions. On examination, the nasal mucosa is clearly swollen and polyps (small growths) or similar changes may be seen. The tongue appears bulky, pink and furrowed, and is covered by white greasy fur. The pulse is weak and hesitant.
3.	Depletion inÂ kidney yang, lungs lose promoting and warmth support from the kidneys
Â	In TCM, the kidney yang is considered to be the fundamental source of promotion and provision of warmth to the body. Depletion of kidney yang usually occurs after long-term or severe damage of organs. It leads to under-functioning of the organs, interrupted flow ofÂ qiÂ andÂ blood, and also affects the functioning of the lung and the nose. On examination, the tongue is pink and covered with moist white fur. The pulse is weak and thready.
4.	Spleen deficiency, stagnation ofÂ phlegm evil
Â	TCM practitioners believe that the spleen and stomach are very vulnerable to an improper diet, invasion byÂ exogenous evils, or the effects of other organ deficiencies. A deficiency or under-functioning of the spleen leads to a decline in qi and blood or acquiredÂ essence (jing)production. The consequence of this is that the body is malnourished and phlegm evil will accumulate. The effect on the nose is to cause it to lose its supply of nutrients and for the nasal mucosa to develop related syndromes. On examination, the tongue is pale and covered by white greasy fur. The pulse is slippery.
5.	Invasion of wind and heat evils in the lungs
Â	When exogenous evils, like wind and heat, attack the protective qi, a nasal disorder usually presents as part of theÂ lung-wei syndrome. On examination, the nasal mucosa is swollen, there is congestion, and some watery discharge, or the discharge may be slightly sticky and thick. The tongue is red and covered with thin fur that may be yellow. The pulse is floating and rapid.

Treatment

Internal Therapy

Â	Deficiency ofÂ lungÂ qi, invasion by wind and coldness evils

Therapeutic aim:To warm up the lungs and aid the protectiveÂ qi, eliminateÂ wind evilÂ and ventilate the nasal passages.

Prescription:Â

huang qi	milk vetch root
bai zhi	large head atractylodes root
fang feng	divaricate saposhnikovia root
bai zhi	dahvrain angelica root
xin yi	blond magnolia flower
cang er zi	Siberian cocklebur fruit
shi chang pu	grassleaf sweet flag rhizome
wu wi zi	Chinese magnolia vine fruit
da zao	Chinese date
xi xin	Manchurian wild ginger
jiu gan cao	liquorice root (processed with honey)

Â	Lung andÂ spleenÂ deficiency, dampness accumulation in the nose

Therapeutic aim:Â To invigorate the spleen and replenish qi, clear upÂ dampness evilÂ and ventilate the nasal passages.

Prescription:Â

huang qi	milk vetch root
bai zhi	large head atractylodes root
chen pi	dried tangerine peel
xin yi	blond magnolia flower
dang shen	pilose asiabell root
chai hu	Chinese tororwax root
gui zhi	cassia twig
bai shao	white peony root
xi xin	Manchurian wild ginger
ma huang	ephedra
wu wi zi	Chinese magnolia vine fruit
jiu gan cao	liquorice root (processed with honey)

Â	Depletion inÂ kidneyÂ yang, lungs lose promoting and warmth support from the kidneys

Therapeutic aim:Â To warm up the kidneys and invigorateÂ yang, benefit the lungs and stop discharge.Â

Prescription:Â

shu di huang	processed rehmannia root
shu fu zi	common monkshood daughter root (processed)
gui zhi	cassia twig
shan yao	common yam root
ze xie	oriental water plantain root
shan zhu yu	Asiatic cornelian cherry fruit
fu ling	Indian bread
huang qi	milk vetch root
bai zhi	large head atractylodes root
fang feng	divaricate saposhnikovia root
xin yi	blond magnolia flower
jiu gan cao	liquorice root (processed with honey)

Â	Spleen deficiency and stagnation ofÂ phlegm evil

Therapeutic aim:Â To reinforce the spleen, clear up dampness evil and ventilate the nasal passages.

Prescription:

dang shen	pilose asiabell root
bai zhi	large head atractylodes root
fu ling	Indian bread
chen pi	dried tangerine peel
fa ban xia	pinellia tuber (processed with radix glycyrrhizae and lime)
jiu gan cao	liquorice root (processed with honey)
xin yi	blond magnolia flower
cang er zi	Siberian cocklebur fruit
bai zhi	dahvrain angelica root
zi wan	tatarian aster root
shan yao	common yam root

Â	Invasion of wind and heat evils in the lungs

Therapeutic aim:Â To expel the heat and phlegm evils, ventilate the nasal passages and stop discharge.

Prescription:Â

huang qin	baical skullcap root
zhi zi	cape jasmine fruit
zhi mu	common anemarrhena rhizome
sang bai pi	white mulberry root-bark
dong gua ren	Chinese waxgourd seed
xin yi	blond magnolia flower
cang er zi	Siberian cocklebur fruit
bai zhi	dahvrain angelica root
jie geng	platycodon root
feng fang	honeycomb
gan cao	liquorice root

External Therapy

Â	Bi-yun powder insufflated into the nose:

e bu shi cao	small centipeda herb
chung xiong	Szechwan lovage rhizome
xin yi	blond magnolia flower
xi xin	Manchurian wild ginger
qing dai	natural indigo

Â	Eardust of yellow croaker tampon inserted into the nose:

yu nao shi powder	eardust of yellow croaker
bing pian	borneol
xin yi	blond magnolia flower
xi xin	Manchurian wild ginger

Acupuncture
The use of acupuncture at the distal and proximal points, or along theÂ meridians, helps to regulate the meridians and qi movement, facilitate the flow of lung qi and ventilate the nose.

Major acupuncture points:Â ying-xiang, shang-xing, he-liao, feng-chi and feng-fu..
Minor acupuncture points:Â bai-hui, yang-bai, cuan-zhu, pi-shu, shen-shu and zu-san-li.Â

Massage
Massage of the lumbar and sacral regions of the spine, especially massage of the acupuncture points ying-heung, shen-shu and ming-men, help to strength theÂ yin and yangÂ of the body and are commonly applied in nasal diseases.

Prevention

Living environment

	Attention should be paid to climatic changes. In the winter and autumn especially, it is important to avoid staying in environments with extreme temperature changes. Suitable clothes should be worn to prevent the invasion ofÂ exogenous evils.
	Exposure to stimulants should be avoided. These include irritant substances such as odor or dust. The living environment (home) should be cleaned regularly. Dry, sunny places should be chosen to live in whenever possible.
Â	Â
	Moderate and regular exercise will help strengthen the body’s resistance.
Â	Â

Dietary management
From a TCM perspective, foods and drugs come from the same source, so foods can have similar properties and functions to those of drugs. Foods and drugs are classified into four characteristics and five tastes. The four characteristics refer to the healing nature of Chinese herbs. These properties are cold, hot, warm and cool. The five tastes are acrid, sweet, sour, bitter and salty.

	During attacks of allergic rhinitis certain foods should be eaten more frequently. These include foods that are acrid tasting, foods that promote warmth and sweating, and foods that facilitate the lung’s dissemination functions. These foods help to eliminate the exogenous evils. Such foods include spring onions, ginger, or cilantro (fresh coriander).
Â	Â
Â	Â
	In general, excessive consumption of cold, greasy, and spicy foods should be avoided. Known sea-food or other foods that trigger the disorder should likewise not be eaten.
Â	Â
Â	Â
	Foods which will tonify, eg, Chinese date, walnut, Chinese yam, dried mushrooms and mutton should be eaten. These foods help to invigorate the qi, cure deficiency,Â tonifyÂ the spleen, build up the body’s resistance.
Â	Â
Â	Â

Yin	Yang
Front (chest-abdomen)	Back
Body	Head
Interior (organs)	Exterior (skin, muscles)
Below waist	Above waist
Anterior-medial	Posterior-lateral
ventral surface of the trunk and limbs	back and dorsal surface of the limbs
Structure	Function
Blood/Body Fluids	Qi
Conservation/storage	Transformation/change
Yin Organs: Heart, Lung,	Small Intestine, Lg. Intestine
Liver, Spleen, Kidney,	Gall Bladder, Stomach, Bladder
Pericardium	San Jiao
“Solid Organs”	“Hollow Organs”

Yin	Yang
Deficiency	Excess
Hypo-activity	Hyperactivity
Chronic disease/gradual onset	Acute disease/rapid onset
Slowly changing symptoms	Rapid pathological changes
Quiet, lethargy, sleepiness	Restlessness, insomnia
Wants to be covered	Throws off bedclothes
Lies curled up	Lies stretched out
Cold limbs and body	Hot limbs and body
Pale face	Red face
Weak voice, no desire to talk	Loud voice, talkative
Shallow, weak breathing	Coarse breathing
No thirst/wants warm drinks	Thirst esp. for cold drinks
Copious, clear urine	Scanty, dark urine
Loose stools (fluids not transformed)	Constipation (damage to fluids by heat)
Clear, copious secretions	Thick, sticky white/yellow secretions
Excessive moisture	Excessive dryness (throat, skin, eyes etc.)
Degenerative disease	Inflammatory disease
Pale tongue, white coat	Red tongue, yellow coat
Empty pulse	Full pulse

1) Excess of Yin	2) Excess of Yang
3) Deficiency of Yin	4) Deficiency of Yang

Excess of Yin (Full Cold)	Excess of Yang (Full Heat)
Excess of Yin is primary aspect	Excess of Yang is primary aspect
Yin is in true excess	Can eventually cause deficiency of Yin
Can eventually cause deficiency of Yang	Â
Â	Â
Deficiency of Yang (Consumption of Yang)	Deficiency of Yin (Consumption of Yin)
(Empty Cold)	(Empty Heat of “False Fire”)
Decrease of Yang energy is primary aspect	Deficiency of Yin is primary aspect
Yin only apparently in excess	Yang only apparently in excess